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Gefitinib, Docetaxel, and Radiation Therapy in Treating Patients With Stage III Non-Small Cell Lung Cancer

Primary Purpose

Lung Cancer

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
docetaxel
gefitinib
laboratory biomarker analysis
radiation therapy
Sponsored by
Wake Forest University Health Sciences
About
Eligibility
Locations
Outcomes
Full info

About this trial

This is an interventional treatment trial for Lung Cancer focused on measuring stage IIIA non-small cell lung cancer, stage IIIB non-small cell lung cancer, adenosquamous cell lung cancer, bronchoalveolar cell lung cancer, large cell lung cancer, squamous cell lung cancer, adenocarcinoma of the lung

Eligibility Criteria

18 Years - 120 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

DISEASE CHARACTERISTICS: Histologically or cytologically confirmed non-small cell lung cancer (NSCLC), including any of the following: Squamous cell carcinoma Adenocarcinoma (including bronchoalveolar cell) Large cell anaplastic carcinoma (including giant and clear cell carcinomas) Stage IIIA/B disease Unresectable disease Tumors adjacent to a vertebral body allowed No demonstrable bone invasion All gross disease must be able to be encompassed in the radiation boost field in accordance with the homogeneity criteria Contralateral mediastinal disease (N3) allowed if all gross disease can be encompassed in the radiation boost field in accordance with the homogeneity criteria No scalene, supraclavicular, or contralateral hilar node involvement Pleural effusion allowed if it is transudate, cytologically negative, and non-bloody AND tumor can be encompassed within a reasonable field of radiotherapy No exudative, bloody, or cytologically malignant effusions Pleural effusion seen on chest CT scan but not on chest x-ray and too small to tap allowed Measurable disease, defined as lesions that can be accurately measured in ≥ 1 dimension (longest diameter to be recorded) as ≥ 20 mm with conventional techniques or as ≥ 10 mm with spiral CT scan No nonmeasurable disease, including any of the following: Bone lesions Leptomeningeal disease Ascites Pleural/pericardial effusion Abdominal masses that are not confirmed and followed by imaging techniques Cystic lesions Tumor lesions situated in a previously irradiated area PATIENT CHARACTERISTICS: ECOG performance status 0-1 Granulocyte count ≥ 1,500/mm^3 Hemoglobin > 8.0 g/dL Platelet count ≥ 100,000/mm^3 Bilirubin < 1.5 mg/dL Creatinine < 1.5 times upper limit of normal (ULN) Meets 1 of the following criteria: AST and ALT < 2 times ULN AST and ALT ≤ 2.5 times ULN AND alkaline phosphatase (AP) normal AST and ALT normal AND AP ≤ 4 times ULN FEV_1 ≥ 1.2 L No other currently active malignancy except nonmelanoma skin cancers Patients are not considered to have another currently active malignancy if they have completed therapy for the other malignancy and are considered by their physician to be at < 30% risk of relapse (i.e., after treatment for early-stage prostate cancer) Not pregnant or nursing Fertile patients must use effective contraception during and for 3 months after completing treatment No history of severe hypersensitivity reaction to docetaxel or other drugs formulated with polysorbate 80 No known severe hypersensitivity to gefitinib or any of the excipients of this product No evidence of severe or uncontrolled systemic disease (e.g., unstable or uncompensated respiratory, cardiac, hepatic, or renal disease) No evidence of any other significant clinical disorder or laboratory finding that would limit compliance with study requirements No evidence of clinically active interstitial lung disease (asymptomatic, chronic stable radiographic changes allowed) No peripheral neuropathy ≥ grade 1 PRIOR CONCURRENT THERAPY: At least 2 weeks since prior formal exploratory thoracotomy No prior chemotherapy or radiotherapy for NSCLC No prior epidermal growth factor-targeting drugs (i.e., gefitinib, erlotinib, or cetuximab) No other investigational agent within 30 days of study entry No concurrent phenytoin, carbamazepine, rifampicin, barbiturates, or Hypericum perforatum (St John's wort) No other concurrent hormonal therapy or chemotherapy except for the following: Steroids for adrenal failure, allergic reactions, or septic shock Hormones for nondisease-related conditions (e.g., insulin for diabetes) Glucocorticosteroids as anti-emetics

Sites / Locations

  • Wake Forest University Comprehensive Cancer Center

Outcomes

Primary Outcome Measures

To determine the feasability of daily ZD1839 delivered with concurrent 3-dimensional planned thoracic radiation

Secondary Outcome Measures

Full Information

First Posted
March 29, 2006
Last Updated
May 25, 2017
Sponsor
Wake Forest University Health Sciences
Collaborators
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT00310154
Brief Title
Gefitinib, Docetaxel, and Radiation Therapy in Treating Patients With Stage III Non-Small Cell Lung Cancer
Official Title
ZD-1839 (Iressa®) With Concurrent Docetaxel and Conformal Three Dimensional Thoracic Radiation Followed by Consolidative Docetaxel and ZD-1839 for Patients With Stage III Non Small Cell Lung Cancer: A Phase I Study
Study Type
Interventional

2. Study Status

Record Verification Date
November 2011
Overall Recruitment Status
Completed
Study Start Date
November 2003 (undefined)
Primary Completion Date
July 2007 (Actual)
Study Completion Date
August 2010 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Wake Forest University Health Sciences
Collaborators
National Cancer Institute (NCI)

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
RATIONALE: Gefitinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy, such as docetaxel, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Radiation therapy uses high-energy x-rays to kill tumor cells. Giving gefitinib together with docetaxel and radiation therapy may kill more tumor cells. PURPOSE: This phase I trial is studying the side effects and best dose of docetaxel when given together with gefitinib and radiation therapy in treating patients with stage III non-small cell lung cancer.
Detailed Description
OBJECTIVES: Determine the maximum tolerated dose of docetaxel that can be safely delivered in combination with gefitinib and a definitive course of 3-D planned thoracic radiotherapy in patients with stage III non-small cell lung cancer. OUTLINE: This is a dose-escalation study of docetaxel. Chemoradiotherapy: Patients receive concurrent chemoradiotherapy comprising docetaxel IV over 30 minutes on day 1 and thoracic radiotherapy once daily on days 1-5 in weeks 1-7 in the absence of disease progression or unacceptable toxicity. Consolidation chemotherapy: Beginning 2 weeks after the completion of chemoradiotherapy, patients receive consolidation chemotherapy comprising docetaxel IV over 60 minutes on days 1 and 22. Gefitinib therapy: Patients also receive oral gefitinib once daily beginning at the start of chemoradiotherapy and continuing for up to 1 year* in the absence of disease progression. NOTE: *Patients continue to receive gefitinib during the 2-week rest period between chemoradiotherapy and consolidation chemotherapy. Cohorts of 3-6 patients receive escalating doses of docetaxel 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. Tumor tissue is tested to determine correlation between epidermal growth factor receptor presence and response to treatment. After completion of study treatment, patients are followed every 3 months for 2 years and then every 6 months for 3 years. PROJECTED ACCRUAL: A total of 45 patients will be accrued in this study.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Lung Cancer
Keywords
stage IIIA non-small cell lung cancer, stage IIIB non-small cell lung cancer, adenosquamous cell lung cancer, bronchoalveolar cell lung cancer, large cell lung cancer, squamous cell lung cancer, adenocarcinoma of the lung

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
45 (Anticipated)

8. Arms, Groups, and Interventions

Intervention Type
Drug
Intervention Name(s)
docetaxel
Intervention Type
Drug
Intervention Name(s)
gefitinib
Intervention Type
Other
Intervention Name(s)
laboratory biomarker analysis
Intervention Type
Radiation
Intervention Name(s)
radiation therapy
Primary Outcome Measure Information:
Title
To determine the feasability of daily ZD1839 delivered with concurrent 3-dimensional planned thoracic radiation
Time Frame
baseline to 2 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
120 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
DISEASE CHARACTERISTICS: Histologically or cytologically confirmed non-small cell lung cancer (NSCLC), including any of the following: Squamous cell carcinoma Adenocarcinoma (including bronchoalveolar cell) Large cell anaplastic carcinoma (including giant and clear cell carcinomas) Stage IIIA/B disease Unresectable disease Tumors adjacent to a vertebral body allowed No demonstrable bone invasion All gross disease must be able to be encompassed in the radiation boost field in accordance with the homogeneity criteria Contralateral mediastinal disease (N3) allowed if all gross disease can be encompassed in the radiation boost field in accordance with the homogeneity criteria No scalene, supraclavicular, or contralateral hilar node involvement Pleural effusion allowed if it is transudate, cytologically negative, and non-bloody AND tumor can be encompassed within a reasonable field of radiotherapy No exudative, bloody, or cytologically malignant effusions Pleural effusion seen on chest CT scan but not on chest x-ray and too small to tap allowed Measurable disease, defined as lesions that can be accurately measured in ≥ 1 dimension (longest diameter to be recorded) as ≥ 20 mm with conventional techniques or as ≥ 10 mm with spiral CT scan No nonmeasurable disease, including any of the following: Bone lesions Leptomeningeal disease Ascites Pleural/pericardial effusion Abdominal masses that are not confirmed and followed by imaging techniques Cystic lesions Tumor lesions situated in a previously irradiated area PATIENT CHARACTERISTICS: ECOG performance status 0-1 Granulocyte count ≥ 1,500/mm^3 Hemoglobin > 8.0 g/dL Platelet count ≥ 100,000/mm^3 Bilirubin < 1.5 mg/dL Creatinine < 1.5 times upper limit of normal (ULN) Meets 1 of the following criteria: AST and ALT < 2 times ULN AST and ALT ≤ 2.5 times ULN AND alkaline phosphatase (AP) normal AST and ALT normal AND AP ≤ 4 times ULN FEV_1 ≥ 1.2 L No other currently active malignancy except nonmelanoma skin cancers Patients are not considered to have another currently active malignancy if they have completed therapy for the other malignancy and are considered by their physician to be at < 30% risk of relapse (i.e., after treatment for early-stage prostate cancer) Not pregnant or nursing Fertile patients must use effective contraception during and for 3 months after completing treatment No history of severe hypersensitivity reaction to docetaxel or other drugs formulated with polysorbate 80 No known severe hypersensitivity to gefitinib or any of the excipients of this product No evidence of severe or uncontrolled systemic disease (e.g., unstable or uncompensated respiratory, cardiac, hepatic, or renal disease) No evidence of any other significant clinical disorder or laboratory finding that would limit compliance with study requirements No evidence of clinically active interstitial lung disease (asymptomatic, chronic stable radiographic changes allowed) No peripheral neuropathy ≥ grade 1 PRIOR CONCURRENT THERAPY: At least 2 weeks since prior formal exploratory thoracotomy No prior chemotherapy or radiotherapy for NSCLC No prior epidermal growth factor-targeting drugs (i.e., gefitinib, erlotinib, or cetuximab) No other investigational agent within 30 days of study entry No concurrent phenytoin, carbamazepine, rifampicin, barbiturates, or Hypericum perforatum (St John's wort) No other concurrent hormonal therapy or chemotherapy except for the following: Steroids for adrenal failure, allergic reactions, or septic shock Hormones for nondisease-related conditions (e.g., insulin for diabetes) Glucocorticosteroids as anti-emetics
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Arthur William Blackstock, MD
Organizational Affiliation
Wake Forest University Health Sciences
Official's Role
Study Chair
First Name & Middle Initial & Last Name & Degree
Antonius A. Miller, MD
Organizational Affiliation
Wake Forest University Health Sciences
Official's Role
Principal Investigator
Facility Information:
Facility Name
Wake Forest University Comprehensive Cancer Center
City
Winston-Salem
State/Province
North Carolina
ZIP/Postal Code
27157-1082
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
20035186
Citation
Center B, Petty WJ, Ayala D, Hinson WH, Lovato J, Capellari J, Oaks T, Miller AA, Blackstock AW. A phase I study of gefitinib with concurrent dose-escalated weekly docetaxel and conformal three-dimensional thoracic radiation followed by consolidative docetaxel and maintenance gefitinib for patients with stage III non-small cell lung cancer. J Thorac Oncol. 2010 Jan;5(1):69-74. doi: 10.1097/JTO.0b013e3181c59a0e.
Results Reference
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Gefitinib, Docetaxel, and Radiation Therapy in Treating Patients With Stage III Non-Small Cell Lung Cancer

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