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Decitabine and Valproic Acid in Treating Patients With Non-Small Cell Lung Cancer

Primary Purpose

Recurrent Non-small Cell Lung Cancer, Stage IV Non-small Cell Lung Cancer

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
decitabine
valproic acid
pharmacological study
laboratory biomarker analysis
Sponsored by
National Cancer Institute (NCI)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Recurrent Non-small Cell Lung Cancer

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Histologically or cytologically confirmed non-small cell lung cancer Tumor accessible to biopsy by bronchoscopy, through surface biopsy (e.g., skin punch biopsy for skin/subcutaneous metastasis) or through CT scan guidance Not eligible for curative surgery, chemotherapy, radiotherapy, or multimodality treatment options No uncontrolled brain metastases Controlled brain metastases allowed provided patient has no neurologic deterioration when off steroids; has completed prior radiotherapy or other treatments; has fully recovered from prior treatment; and does not require anticonvulsants Performance status - ECOG 0-2 Performance status - Karnofsky 60-100% More than 12 weeks Absolute neutrophil count > 1,500/mm^3 Platelet count > 100,000/mm^3 WBC > 3,000/mm^3 AST and ALT =< 2.5 times upper limit of normal (ULN) Bilirubin =< 1.5 times ULN Creatinine =< 1.5 times ULN Creatinine clearance >= 60 mL/min No symptomatic congestive heart failure No unstable angina pectoris No cardiac arrhythmia Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception No prior allergic reaction to compounds of similar chemical or biological composition to decitabine, valproic acid, or other study agents No other concurrent uncontrolled illness No ongoing or active infection requiring antibiotics No history of seizures requiring anticonvulsants No medical problem that would preclude study participation No psychiatric illness or social situation that would preclude study compliance No other active malignancy except non-melanoma skin cancer or carcinoma in situ of the cervix No concurrent prophylactic growth factors (e.g., filgrastim [G-CSF] or epoetin alfa) No more than 3 prior chemotherapy regimens More than 3 weeks since prior chemotherapy (6 weeks for nitrosoureas or mitomycin) and recovered Prior definitive radiotherapy to the chest allowed Clinical (radiographic or other) evidence of tumor progression for previously irradiated indicator lesion in the chest More than 2 weeks since prior radiotherapy and recovered No concurrent palliative radiotherapy Prior curative or palliative intent surgery allowed At least 2 weeks since prior surgery and recovered At least 4 weeks since prior photodynamic therapy No concurrent combination antiretroviral therapy for HIV-positive patients No other concurrent anticancer agents or therapies No other concurrent investigational agents No concurrent administration of any of the following medications: Aspirin Chronic low-dose (=< 81 mg/day) aspirin allowed Felbamate Rifampin Amitriptyline Nortriptyline Carbamazepine Clonazepam Diazepam Ethosuximide Lamotrigine Phenobarbital Barbiturates Primidone Phenytoin Zidovudine No concurrent divalproex sodium Concurrent gabapentin for neuropathic pain allowed

Sites / Locations

  • Ohio State University Medical Center

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Treatment (decitabine, valproic acid)

Arm Description

Patients receive decitabine IV over 1 hour on days 1-10 and oral valproic acid three times daily on days 5-21. Treatment repeats every 28 days for 6 courses in the absence of disease progression or unacceptable toxicity. Cohorts of 3-6 patients receive escalating doses of decitabine and valproic acid until the MTD is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity. After the MTD is determined, an additional 6 patients are treated at that dose.

Outcomes

Primary Outcome Measures

MTD, defined as dose in which fewer than 1/3 or 2/6 patients experience DLT

Secondary Outcome Measures

Full Information

First Posted
June 10, 2004
Last Updated
September 27, 2013
Sponsor
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT00084981
Brief Title
Decitabine and Valproic Acid in Treating Patients With Non-Small Cell Lung Cancer
Official Title
A Phase I Study of Decitabine in Combination With Valproic Acid in Patients With Non-Small Cell Lung Cancer
Study Type
Interventional

2. Study Status

Record Verification Date
September 2013
Overall Recruitment Status
Completed
Study Start Date
April 2004 (undefined)
Primary Completion Date
February 2013 (Actual)
Study Completion Date
undefined (undefined)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
National Cancer Institute (NCI)

4. Oversight

5. Study Description

Brief Summary
This phase I trial is studying the side effects and best dose of decitabine and valproic acid in treating patients with non-small cell lung cancer. Drugs used in chemotherapy, such as decitabine and valproic acid, work in different ways to stop tumor cells from dividing so they stop growing or die. Combining more than one drug may kill more tumor cells.
Detailed Description
PRIMARY OBJECTIVES: I. Determine the safety and tolerability of decitabine and valproic acid in patients with non-small cell lung cancer. II. Determine the recommended phase II dose of this regimen in these patients. SECONDARY OBJECTIVES: I. Determine the ability of this regimen to lead to biological changes in tumor and surrogate tissues in these patients, including hypomethylation of target genes known to be methylated in NSCLC (CDKN2, APC, BMP3B, CDH1 and RASSF1A) in biopsy specimens and surrogate tissues (peripheral blood mononuclear cells [PBMC] and plasma/serum DNA); acetylation and methylation changes in histones from tumor and surrogate tissues (PBMC and oral epithelial cells); inhibition of histone deacetylase (HDAC) activity in peripheral blood; pharmacokinetic analysis of Decitabine and Valproic Acid; DNA methyltransferase 1 (DNMT1) protein loss in PBMC and buccal cells; response of hemoglobin F in patients with non-hematologic conditions to DNMT and HDAC inhibition; and preliminary evidence of antitumor activity in non-small cell lung cancer. OUTLINE: This is a dose-escalation study. Patients receive decitabine IV over 1 hour on days 1-10 and oral valproic acid three times daily on days 5-21. Treatment repeats every 28 days for 6 courses in the absence of disease progression or unacceptable toxicity. Cohorts of 3-6 patients receive escalating doses of decitabine and valproic acid until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity. After the MTD is determined, an additional 6 patients are treated at that dose.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Recurrent Non-small Cell Lung Cancer, Stage IV Non-small Cell Lung Cancer

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
25 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Treatment (decitabine, valproic acid)
Arm Type
Experimental
Arm Description
Patients receive decitabine IV over 1 hour on days 1-10 and oral valproic acid three times daily on days 5-21. Treatment repeats every 28 days for 6 courses in the absence of disease progression or unacceptable toxicity. Cohorts of 3-6 patients receive escalating doses of decitabine and valproic acid until the MTD is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity. After the MTD is determined, an additional 6 patients are treated at that dose.
Intervention Type
Drug
Intervention Name(s)
decitabine
Other Intervention Name(s)
5-aza-dCyd, 5AZA, DAC
Intervention Description
Given IV
Intervention Type
Drug
Intervention Name(s)
valproic acid
Other Intervention Name(s)
Alti-Valproic, Depakene, Novo-Valproic, VA
Intervention Description
Given PO
Intervention Type
Other
Intervention Name(s)
pharmacological study
Other Intervention Name(s)
pharmacological studies
Intervention Description
Correlative studies
Intervention Type
Other
Intervention Name(s)
laboratory biomarker analysis
Intervention Description
Correlative studies
Primary Outcome Measure Information:
Title
MTD, defined as dose in which fewer than 1/3 or 2/6 patients experience DLT
Time Frame
28 days

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Histologically or cytologically confirmed non-small cell lung cancer Tumor accessible to biopsy by bronchoscopy, through surface biopsy (e.g., skin punch biopsy for skin/subcutaneous metastasis) or through CT scan guidance Not eligible for curative surgery, chemotherapy, radiotherapy, or multimodality treatment options No uncontrolled brain metastases Controlled brain metastases allowed provided patient has no neurologic deterioration when off steroids; has completed prior radiotherapy or other treatments; has fully recovered from prior treatment; and does not require anticonvulsants Performance status - ECOG 0-2 Performance status - Karnofsky 60-100% More than 12 weeks Absolute neutrophil count > 1,500/mm^3 Platelet count > 100,000/mm^3 WBC > 3,000/mm^3 AST and ALT =< 2.5 times upper limit of normal (ULN) Bilirubin =< 1.5 times ULN Creatinine =< 1.5 times ULN Creatinine clearance >= 60 mL/min No symptomatic congestive heart failure No unstable angina pectoris No cardiac arrhythmia Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception No prior allergic reaction to compounds of similar chemical or biological composition to decitabine, valproic acid, or other study agents No other concurrent uncontrolled illness No ongoing or active infection requiring antibiotics No history of seizures requiring anticonvulsants No medical problem that would preclude study participation No psychiatric illness or social situation that would preclude study compliance No other active malignancy except non-melanoma skin cancer or carcinoma in situ of the cervix No concurrent prophylactic growth factors (e.g., filgrastim [G-CSF] or epoetin alfa) No more than 3 prior chemotherapy regimens More than 3 weeks since prior chemotherapy (6 weeks for nitrosoureas or mitomycin) and recovered Prior definitive radiotherapy to the chest allowed Clinical (radiographic or other) evidence of tumor progression for previously irradiated indicator lesion in the chest More than 2 weeks since prior radiotherapy and recovered No concurrent palliative radiotherapy Prior curative or palliative intent surgery allowed At least 2 weeks since prior surgery and recovered At least 4 weeks since prior photodynamic therapy No concurrent combination antiretroviral therapy for HIV-positive patients No other concurrent anticancer agents or therapies No other concurrent investigational agents No concurrent administration of any of the following medications: Aspirin Chronic low-dose (=< 81 mg/day) aspirin allowed Felbamate Rifampin Amitriptyline Nortriptyline Carbamazepine Clonazepam Diazepam Ethosuximide Lamotrigine Phenobarbital Barbiturates Primidone Phenytoin Zidovudine No concurrent divalproex sodium Concurrent gabapentin for neuropathic pain allowed
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Gregory Otterson
Organizational Affiliation
Ohio State University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Ohio State University Medical Center
City
Columbus
State/Province
Ohio
ZIP/Postal Code
43210
Country
United States

12. IPD Sharing Statement

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Decitabine and Valproic Acid in Treating Patients With Non-Small Cell Lung Cancer

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