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Combination Chemotherapy, Radiation Therapy, and Gefitinib in Treating Patients With Stage III Non-Small Cell Lung Cancer
This study has been completed.

First Received on July 8, 2002.   Last Updated on March 30, 2011   History of Changes
Sponsor: Cancer and Leukemia Group B
Collaborator: National Cancer Institute (NCI)
Information provided by: Cancer and Leukemia Group B
ClinicalTrials.gov Identifier: NCT00040794
  Purpose

RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Biological therapies such as gefitinib may interfere with the growth of cancer cells and slow the growth of the tumor. Radiation therapy uses high-energy x-rays to damage tumor cells. Combining more than one chemotherapy drug with gefitinib and radiation therapy may kill more tumor cells.

PURPOSE: Phase II trial to study the effectiveness of combining different regimens of chemotherapy and gefitinib with radiation therapy in treating patients who have stage III non-small cell lung cancer.


Condition Intervention Phase
Lung Cancer
Drug: carboplatin
Drug: gefitinib
Drug: paclitaxel
Radiation: radiation therapy
Phase II

Study Type: Interventional
Study Design: Allocation: Non-Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Induction Paclitaxel And Carboplatin Followed By Either Radiation Or Concomitant Radiation With Weekly Paclitaxel And Carboplatin In Stage III Non-Small Cell Lung Cancer. A Phase II Study

Resource links provided by NLM:


Further study details as provided by Cancer and Leukemia Group B:

Primary Outcome Measures:
  • Survival [ Time Frame: >13 mon Strtm I; > 14.5 mon Strtm II ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Toxicity [ Time Frame: after cycles 2 & 9, q mon during maintenance ] [ Designated as safety issue: Yes ]

Enrollment: 63
Study Start Date: May 2002
Study Completion Date: March 2006
Primary Completion Date: March 2006 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Stratum I
Patients receive oral gefitinib once daily for 7 weeks. Patients also undergo concurrent radiotherapy once daily 5 days a week for 7 weeks.
Drug: gefitinib
Given orally
Radiation: radiation therapy
Patients undergo radiation therapy once daily 5 days a week for 7 weeks.
Experimental: Stratum II
Patients receive gefitinib and radiotherapy as in stratum I concurrently with paclitaxel IV over 1 hour followed by carboplatin over 30 minutes once weekly for 7 weeks.
Drug: carboplatin
Given IV
Drug: gefitinib
Given orally
Drug: paclitaxel
Given IV
Radiation: radiation therapy
Patients undergo radiation therapy once daily 5 days a week for 7 weeks.

Detailed Description:

OBJECTIVES:

  • Determine the tolerability of paclitaxel and carboplatin followed by radiotherapy with or without paclitaxel and carboplatin followed by gefitinib in patients with stage III non-small cell lung cancer.
  • Determine the overall response rate, failure-free survival, and survival in patients treated with these regimens.

OUTLINE: This is a multicenter study. Patients are stratified according to CTC performance status (PS) and recent weight loss (PS 2 or PS 0-1 with weight loss of 5% or more within the past 3 months [stratum I] vs PS 0-1 with weight loss less than 5% within the past 3 months [stratum II]).

All patients receive induction therapy comprising paclitaxel IV over 3 hours followed by carboplatin IV over 30 minutes on day 1. Treatment repeats every 21 days for 2 courses. Patients then receive therapy based on their assigned stratum.

  • Stratum I: Patients receive oral gefitinib once daily for 7 weeks. Patients also undergo concurrent radiotherapy once daily 5 days a week for 7 weeks.
  • Stratum II: Patients receive gefitinib and radiotherapy as in stratum I concurrently with paclitaxel IV over 1 hour followed by carboplatin over 30 minutes once weekly for 7 weeks.

Patients are followed every 2 months for 2 years, every 4 months for 2 years, and then annually for 2 years.

PROJECTED ACCRUAL: A total of 18-144 patients (9-72 per stratum) will be accrued for this study within 13 months.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

DISEASE CHARACTERISTICS:

  • Histologically or cytologically confirmed non-small cell lung cancer (NSCLC)

    • Squamous cell carcinoma
    • Adenocarcinoma (including bronchoalveolar cell)
    • Large cell anaplastic carcinoma (including giant and clear cell carcinoma)
  • Unresectable stage IIIA or selected stage IIIB disease

    • T1-2, N2 disease allowed
    • T3, N2 or T4, N0-2 disease allowed if based on closeness to carina, invasion of mediastinum, or invasion of chest wall
    • No T3, N0-1 disease
    • No M1 disease
    • No direct invasion of vertebral body
  • Tumors adjacent to a vertebral body allowed if no bone invasion and if all gross disease can be encompassed in radiation boost field
  • Contralateral mediastinal disease (N3) allowed if all gross disease can be encompassed in radiation boost field
  • No scalene, supraclavicular, or contralateral hilar node involvement
  • Transudate, cytologically negative, non-bloody pleural effusion allowed if the tumor can be encompassed in radiotherapy field

    • Pleural effusions seen on chest CT scan but not on chest x-ray that are too small to tap are allowed
    • Pleural effusions appearing only after thoracotomy or other invasive thoracic procedure are allowed
  • Measurable disease

    • At least 20 mm by conventional techniques OR at least 10 mm by spiral CT scan
    • The following are not considered measurable:

      • Pleural effusions
      • Completely resected tumors
      • Ill-defined masses with post-obstructive changes

PATIENT CHARACTERISTICS:

Age:

  • 18 and over

Performance status:

  • CTC 0-2

Life expectancy:

  • Not specified

Hematopoietic:

  • Granulocyte count at least 1,500/mm^3
  • Platelet count at least 100,000/mm^3

Hepatic:

  • Bilirubin less than 1.5 mg/dL
  • AST less than 2 times upper limit of normal
  • No chronic liver disease

Renal:

  • Creatinine clearance at least 20 mL/min

Cardiovascular:

  • No symptomatic congestive heart failure
  • No unstable angina pectoris
  • No cardiac arrhythmia

Other:

  • Not pregnant or nursing
  • Fertile patients must use effective contraception
  • No other concurrent uncontrolled illness
  • No ongoing or active infection
  • No other currently active malignancy (must have completed therapy and be at less than 30% risk of relapse to be eligible) except nonmelanoma skin cancer
  • No chronic gastrointestinal disorders (e.g., diarrhea or emetic disorders or malabsorptive conditions) that would preclude study participation
  • No psychiatric illness or social situation that would preclude study participation

PRIOR CONCURRENT THERAPY:

Biologic therapy:

  • Not specified

Chemotherapy:

  • No prior chemotherapy for NSCLC
  • No other concurrent chemotherapy

Endocrine therapy:

  • No concurrent hormonal therapy except steroids for adrenal failure, hormonal therapy for non-disease-related conditions (e.g., insulin for diabetes), or intermittent use of dexamethasone as antiemetic

Radiotherapy:

  • See Disease Characteristics
  • No prior radiotherapy for NSCLC
  • No concurrent palliative radiotherapy

Surgery:

  • At least 2 weeks since prior formal exploratory thoracotomy

Other:

  • At least 7 days since prior CYP3A4 inducers (e.g., phenytoin, carbamazepine, barbiturates, rifampin, dexamethasone, or Hypericum perforatum [St. John's wort])
  • No concurrent CYP3A4 inducers
  • No concurrent combination antiretroviral therapy in HIV-positive patients
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00040794

Locations
United States, Florida
Michael and Dianne Bienes Comprehensive Cancer Center at Holy Cross Hospital
Fort Lauderdale, Florida, United States, 33308
Ella Milbank Foshay Cancer Center at Jupiter Medical Center
Jupiter, Florida, United States, 33458
CCOP - Mount Sinai Medical Center
Miami Beach, Florida, United States, 33140
United States, Nebraska
Saint Francis Cancer Treatment Center at Saint Francis Memorial Health Center
Grand Island, Nebraska, United States, 68803
Callahan Cancer Center at Great Plains Regional Medical Center
North Platte, Nebraska, United States, 69103
UNMC Eppley Cancer Center at the University of Nebraska Medical Center
Omaha, Nebraska, United States, 68198-6805
United States, New York
SUNY Upstate Medical University Hospital
Syracuse, New York, United States, 13210
United States, Rhode Island
Miriam Hospital
Providence, Rhode Island, United States, 02906
Rhode Island Hospital Comprehensive Cancer Center
Providence, Rhode Island, United States, 02903
United States, Vermont
Mountainview Medical
Berlin, Vermont, United States, 05602
Fletcher Allen Health Care - University Health Center Campus
Burlington, Vermont, United States, 05401
Sponsors and Collaborators
Cancer and Leukemia Group B
Investigators
Study Chair: Neal Ready, MD, PhD Duke University
  More Information

Additional Information:
Publications:
Ready N, Jänne PA, Bogart J, Dipetrillo T, Garst J, Graziano S, Gu L, Wang X, Green MR, Vokes EE; for the Cancer, Leukemia Group B, Chicago, IL. Chemoradiotherapy and Gefitinib in Stage III Non-small Cell Lung Cancer with Epidermal Growth Factor Receptor and KRAS Mutation Analysis: Cancer and Leukemia Group B (CALEB) 30106, a CALGB-Stratified Phase II Trial. J Thorac Oncol. 2010 Aug 3; [Epub ahead of print]
Ready N, Janne P, Herndon J, et al.: Chemoradiotherapy (CRT) and gefitinib (G) in stage III non-small cell lung cancer (NSCLC): a CALGB stratified phase II trial. [Abstract] J Clin Oncol 24 (Suppl 18): 7046, 375s, 2006.
Ready N, Herndon J, Vokes E, et al.: Initial cohort toxicity evaluation for chemoradiotherapy (CRT) and ZD1839 in stage III non-small cell lung cancer (NSCLC): a CALGB stratified phase II trial. [Abstract] J Clin Oncol 22 (Suppl 14): A-7078, 635s, 2004.

Responsible Party: Monica M Bertagnolli, MD, Cancer and Leukemia Group B
ClinicalTrials.gov Identifier: NCT00040794     History of Changes
Other Study ID Numbers: CDR0000069407, U10CA031946, CALGB-30106
Study First Received: July 8, 2002
Last Updated: March 30, 2011
Health Authority: United States: Food and Drug Administration

Keywords provided by Cancer and Leukemia Group B:
squamous cell lung cancer
large cell lung cancer
stage IIIA non-small cell lung cancer
stage IIIB non-small cell lung cancer
adenocarcinoma of the lung
bronchoalveolar cell lung cancer

Additional relevant MeSH terms:
Carcinoma, Non-Small-Cell Lung
Lung Neoplasms
Carcinoma, Bronchogenic
Bronchial Neoplasms
Respiratory Tract Neoplasms
Thoracic Neoplasms
Neoplasms by Site
Neoplasms
Lung Diseases
Respiratory Tract Diseases
Gefitinib
Carboplatin
Paclitaxel
Antineoplastic Agents
Therapeutic Uses
Pharmacologic Actions
Tubulin Modulators
Antimitotic Agents
Mitosis Modulators
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents, Phytogenic
Protein Kinase Inhibitors
Enzyme Inhibitors

ClinicalTrials.gov processed this record on February 09, 2012