Gene Therapy in Treating Patients With Non-small Cell Lung Cancer That Cannot Be Surgically Removed

Phase I Pilot Trial of Adenovirus p53 in Bronchioloalveolar Cell Lung Carcinoma (BAC) Administered by Bronchoalveolar Lavage

RATIONALE: Exposing tumor cells to the p53 gene may improve the body's ability to fight non-small cell lung cancer. PURPOSE: Phase I trial to study the effectiveness of gene therapy in treating patients who have non-small cell lung cancer that cannot be surgically removed.

OBJECTIVES: Evaluate the safety of multiple endobronchial treatments with adenovirus p53 bronchoalveolar lavage of a single lobe of the lung in patients with bronchoalveolar cell lung carcinoma. Evaluate expression of the p53 gene and induction of apoptosis in tumor and normal tissues exposed to the virus in these patients. Evaluate whether transbronchial administration of adenovirus p53 results in improved local tumor control in these patients. OUTLINE: This is a dose escalation study. Patients undergo biopsy and receive adenovirus p53 by bronchoalveolar lavage on days 1 and 15. Patients repeat biopsy on days 3 and 28. If there is evidence of clinical benefit or response without significant toxicity, patients may receive a maximum of 3 courses. Treatment beyond 3 courses must be approved by protocol investigator. Cohorts of 3 patients are treated at escalating dose levels of adenovirus p53. Patients in each cohort are followed for dose limiting toxicity (DLT) for 2 weeks after completion of one course before dose escalation proceeds in subsequent cohorts. If 1 of 3 patients at a dose level experiences dose limiting toxicity (DLT), then 2 additional patients are entered at the same dose level. If more than 1 of 5 patients experience DLT, the previous dose is the maximum tolerated dose (MTD). An additional 10 patients are treated at the MTD. Patients are followed every 3 months for the first 2 years, every 6 months for the next 3 years, and annually thereafter. PROJECTED ACCRUAL: There will be 15 patients accrued into this study over 1 year.

recurrent non-small cell lung cancer, stage IIIB non-small cell lung cancer, stage IV non-small cell lung cancer, bronchoalveolar cell lung cancer

DISEASE CHARACTERISTICS: Histologically confirmed unresectable non-small cell lung cancer with a growth pattern allowing access to the majority of tumor cells via the airway (e.g., bronchioloalveolar or papillary adenocarcinoma) PATIENT CHARACTERISTICS: Age: 18 and over Performance status: ECOG 0-1 Life expectancy: At least 12 weeks Hematopoietic: Platelet count greater than 100,000/mm^3 Prothrombin time and partial thromboplastin time normal Hepatic: Bilirubin less than 1.5 mg/dL Renal: Creatinine less than 1.5 mg/dL Cardiovascular: No New York Heart Association class III or IV heart disease Pulmonary: Room air oxygen saturation greater than 90% FEV1 greater than 1.0 L pCO2 less than 50 Other: HIV negative No active systemic viral, bacterial, or fungal infections requiring treatment No concurrent illness requiring hospitalization or intravenous medication Not pregnant or nursing Effective contraception required of all fertile patients PRIOR CONCURRENT THERAPY: Biologic therapy: No prior adenovirus gene therapy At least 2 weeks since any systemic biologic therapy including prior biologic response modifiers and recovered Chemotherapy: At least 2 weeks since any prior systemic chemotherapy and recovered Endocrine therapy: Recovered from any prior endocrine therapy Radiotherapy: Recovered from any prior radiotherapy Surgery: At least 2 weeks since any surgical procedure requiring anesthesia At least 4 weeks since prior surgical resection of lung tissues Other: No other concurrent therapy

Keedy V, Wang W, Schiller J, Chada S, Slovis B, Coffee K, Worrell J, Thet LA, Johnson DH, Carbone DP. Phase I study of adenovirus p53 administered by bronchoalveolar lavage in patients with bronchioloalveolar cell lung carcinoma: ECOG 6597. J Clin Oncol. 2008 Sep 1;26(25):4166-71. doi: 10.1200/JCO.2007.15.6927.

Kubba SV, Adak S, Schiller J, et al.: Phase I trial of adenovirus p53 in bronchioalveolar cell lung carcinoma (BAC) administered by bronchioalveolar lavage. [Abstract] Proceedings of the American Society of Clinical Oncology 19: A1904, 2000.