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Phase 1b/2 Study of Carfilzomib, Carboplatin, and Etoposide in Patients With Previously Untreated Extensive Stage Small-cell Lung Cancer

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ClinicalTrials.gov Identifier: NCT01987232
Recruitment Status : Completed
First Posted : November 19, 2013
Results First Posted : August 28, 2017
Last Update Posted : August 28, 2017
Sponsor:
Information provided by (Responsible Party):
Amgen

Brief Summary:
The purpose of this study is to determine the maximum tolerated dose and assess the safety, tolerability and activity of carfilzomib given in combination with carboplatin and etoposide as initial therapy for patients with extensive-stage small-cell lung cancer (ES SCLC).

Condition or disease Intervention/treatment Phase
Extensive-Stage Small-Cell Lung Cancer Drug: Carfilzomib Drug: Carboplatin Drug: Etoposide Phase 1 Phase 2

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 32 participants
Intervention Model: Sequential Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Phase 1b/2, Multicenter, Open-label Study of Carfilzomib, Carboplatin, and Etoposide in Subjects With Previously Untreated Extensive-stage Small-cell Lung Cancer
Study Start Date : November 5, 2013
Actual Primary Completion Date : August 2016
Actual Study Completion Date : May 4, 2017


Arm Intervention/treatment
Experimental: Carfilzomib Combination
Participants received carfilzomib on days 2, 3, 9, and 10 of each 21-day cycle as per the dose escalation schema, carboplatin at a target area under the curve (AUC) of 5 on day 1 of each cycle, and etoposide 100 mg/m² on days 1, 2, 3 of each 21-day cycle for up to 6 cycles. Participants with stable disease or better continued to receive carfilzomib alone until progressive disease (PD), unacceptable toxicity, withdrawal of consent, study closure, or death, whichever occurred earliest.
Drug: Carfilzomib
Administered by intravenous infusion.
Other Names:
  • PR-171
  • PR171
  • Kyprolis®

Drug: Carboplatin
Administered by intravenous infusion.

Drug: Etoposide
Administered by intravenous infusion.




Primary Outcome Measures :
  1. Number of Participants With Dose-limiting Toxicities [ Time Frame: First 21-day Cycle ]

    The maximum tolerated dose (MTD) was defined as the highest dose level at which < 33% of participants experienced a dose-limiting toxicity (DLT) during the first 21-day cycle. Dose-limiting toxicities were evaluated according to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE) Version 4.03. A DLT was defined as:

    • A grade 3 or greater non-hematologic toxicity that was assessed as related to carfilzomib by the investigator except in the case of neuropathy. A grade 2 or higher neuropathy with pain was considered a DLT.
    • Grade 4 neutropenia: absolute neutrophil count (ANC) < 500 mm³, lasting ≥ 7 days despite granulocyte colony stimulating factor support, or any febrile (temperature > 38.3°C) neutropenia (ANC < 1000 mm³).
    • Thrombocytopenia of any grade associated with clinically significant bleeding or platelet/blood transfusion
    • Grade 4 fatigue lasting ≥ 7 days
    • Grade 3 nausea, vomiting or diarrhea lasting ≥ 7 days.


Secondary Outcome Measures :
  1. Number of Participants With Adverse Events (AEs) [ Time Frame: From first day of any study treatment (i.e., carfilzomib, carboplatin, or etoposide) up to 30 days after the last day of study treatment. The median overall duration of treatment was 16 weeks. ]

    The severity of each adverse event was assessed using the NCI-CTCAE Version 4.03 according to the following:

    Grade 1 - Mild: Asymptomatic or mild symptoms; intervention not indicated

    Grade 2 - Moderate: Minimal, local or noninvasive intervention indicated; limiting age-appropriate instrumental activities of daily living (ADL)

    Grade 3 - Severe: Medically significant but not life-threatening; hospitalization or prolongation of hospitalization indicated; disabling; limiting self-care ADL

    Grade 4 - Life-threatening

    Grade 5 - Fatal.

    A serious AE is an AE that met one or more of the following criteria:

    • Death
    • Life-threatening
    • Required inpatient hospitalization or prolongation of an existing hospitalization
    • Resulted in persistent or significant disability/incapacity
    • A congenital anomaly/birth defect
    • Important medical events that required medical or surgical intervention to prevent one of the outcomes above.

  2. Overall Survival (OS) - Phase 2 [ Time Frame: 30 months ]
    Overall Survival (OS) is defined as the time from randomization to the date of death. Overall survival was a specified secondary endpoint for the phase 2 portion of the study; since phase 2was not conducted, OS was not analyzed.

  3. Maximum Plasma Concentration - Phase 2 [ Time Frame: Cycle 1 Day 2 ]
    Pharmacokinetic (PK) analyses were specified as secondary endpoints for the phase 2 portion of the study; since phase 2 was not conducted, PK analyses were not performed.

  4. Time of Maximum Plasma Concentration - Phase 2 [ Time Frame: Cycle 1 Day 2 ]
    Pharmacokinetic (PK) analyses were specified as secondary endpoints for the phase 2 portion of the study; since phase 2 was not conducted, PK analyses were not performed.

  5. Area Under Plasma Concentration-Time Curve - Phase 2 [ Time Frame: Cycle 1 Day 2 ]
    Pharmacokinetic (PK) analyses were specified as secondary endpoints for the phase 2 portion of the study; since phase 2 was not conducted, PK analyses were not performed.


Other Outcome Measures:
  1. Progression-free Survival [ Time Frame: From first dose of study drug until the end of treatment; median duration of treatment was 16 weeks. ]

    Progression-free survival (PFS) was specified as a primary endpoint for the phase 2 portion of the study. Since phase 2 did not proceed PFS was analyzed in phase 1b participants on an exploratory basis. PFS was defined as the time from the start of treatment to documented disease progression or death due to any cause, whichever occurred first. Disease progression was determined by the investigator according to the Response Evaluation Criteria in Solid Tumors (RECIST) v1.1, defined as at least a 20% increase in the size of target lesions (absolute increase ≥ 5 mm), unequivocal progression of existing non-target lesions, or any new lesions.

    Median PFS was calculated using Kaplan-Meier methods. Participants with no baseline disease assessments, who started a new anticancer therapy before documentation of PD or death, with death or PD immediately after more than 1 consecutively missed disease assessment visit or alive without documentation of PD before the data cutoff date were censored.


  2. Overall Response Rate [ Time Frame: From first dose of study drug until the end of treatment; median duration of treatment was 16 weeks. ]

    The overall response rate (ORR) was defined as the percentage of participants for whom the best overall confirmed response was either complete response (CR) or partial response (PR) assessed by the investigator according to RECIST v1.1 criteria.

    CR: Disappearance of all target and non-target lesions, no new lesions and normalization of tumor marker levels. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to < 10 mm.

    PR: At least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum of diameters, or, the disappearance of all target lesions and persistence of one or more non-target lesion(s) and/or maintenance of tumor marker levels above normal limits.


  3. Duration of Response [ Time Frame: From first dose of study drug until the end of treatment; median duration of treatment was 16 weeks. ]

    Duration of response (DOR) was calculated for participants who achieved a confirmed CR or PR. defined as the time from first evidence of confirmed PR/CR to disease progression or death due to any cause. Median DOR was calculated using Kaplan-Meier methods. Participants with no baseline disease assessments, who started a new anticancer therapy before documentation of PD or death, with death or PD immediately after more than 1 consecutively missed disease assessment visit or alive without documentation of PD before the data cutoff date were censored.

    DOR was originally specified as a secondary endpoint for the phase 2 portion of the study. Since phase 2 did not proceed, DOR was analyzed in phase 1b participants on an exploratory basis.




Information from the National Library of Medicine

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

Key Inclusion Criteria:

  1. Histologically or cytologically confirmed diagnosis of extensive-stage small-cell lung cancer (ES-SCLC) with measurable disease per Response Evaluation Criteria in Solid Tumors (RECIST) Version 1.1; ES-SCLC is defined as: small-cell lung cancer (SCLC) that has spread beyond one hemithorax and regional lymph nodes on the same side (e.g., supraclavicular) to the contralateral hemithorax, lymph nodes, or more distant locations in the body
  2. Subjects with asymptomatic brain metastases or other central nervous system (CNS) disease at screening/diagnosis are eligible
  3. Males and females ≥ 18 years of age
  4. Eastern Cooperative Oncology Group (ECOG) performance status 0-1

Key Exclusion Criteria:

  1. Previous systemic therapy to treat small-cell lung cancer (SCLC). Subjects with recurrent or progressive limited-stage SCLC after previous systemic treatment are not eligible for study participation.
  2. Whole brain or focal radiation therapy within 14 days prior to Cycle 1 Day 1 (C1D1) for Phase 1b or prior to randomization for Phase 2
  3. Congestive heart failure (New York Heart Association [NYHA] class III to IV), symptomatic ischemia, conduction abnormalities uncontrolled by conventional intervention, or myocardial infarction within 6 months prior to prior to C1D1 for Phase 1b or prior to randomization for Phase 2

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): NCT01987232


Locations
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Sponsors and Collaborators
Amgen
Investigators
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Study Director: MD Amgen
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Responsible Party: Amgen
ClinicalTrials.gov Identifier: NCT01987232    
Other Study ID Numbers: CFZ004
2013-002597-44 ( EudraCT Number )
20130399 ( Other Identifier: Amgen Inc. )
First Posted: November 19, 2013    Key Record Dates
Results First Posted: August 28, 2017
Last Update Posted: August 28, 2017
Last Verified: July 2017
Additional relevant MeSH terms:
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Lung Neoplasms
Small Cell Lung Carcinoma
Respiratory Tract Neoplasms
Thoracic Neoplasms
Neoplasms by Site
Neoplasms
Lung Diseases
Respiratory Tract Diseases
Carcinoma, Bronchogenic
Bronchial Neoplasms
Carboplatin
Etoposide
Antineoplastic Agents
Antineoplastic Agents, Phytogenic
Topoisomerase II Inhibitors
Topoisomerase Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action