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Phase I/II Study to Evaluate the Efficacy and Safety of a Combination Chemotherapy

Primary Purpose

Lung Cancer

Status

Terminated

Phase

Phase 1

Locations

United States

Study Type

Interventional

Intervention

Bortezomib 1.3 mg/m2

Bortezomib 1.6 mg/m2

Bortezomib 1.8 mg/m2

Carboplatin AUC 6

Bevacizumab

Taxotere

About this trial

This is an interventional treatment trial for Lung Cancer focused on measuring lung cancer, Carboplatin, bortezomib, Bevacizumab

Eligibility Criteria

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

Inclusion Criteria:

Histologically confirmed SCLC (adeno- and large cell, anaplastic carcinoma and broncho-alveolar-carcinoma). Patients with squamous-cell histology are eligible with extra thoracic or peripheral lung lesions only.
Sputum cytology alone not acceptable evidence of cell type. Cytologic specimens obtained by brushing, washings, or needle aspiration of defined lesions will be acceptable. Mixed tumors will be categorized by the predominant cell type unless a small cell anaplastic elements are present, in which case the patient is ineligible.
Stage III B because of pleural effusion or Stage IV disease
Measurable disease.
Age: 18 years or older
No history of thrombotic, hemorrhagic, or coagulopathy disorders
international normalized ratio (INR<1.5) and a prothrombin time (PTT) no greater than normal limits of normal within 1 week prior to registration. NB: subjects with lung cancer placed on anticoagulant therapy for a thrombotic event are not eligible for this study.
No gross hemoptysis (defined as bright red blood of ½ teaspoon or more)
No central nervous system (CNS) or brain metastasis
Laboratory Criteria (completed <2 weeks before enrollment):
- Hematologic: white blood cell (WBC) > 3500/mm3 or absolute neutrophil count (ANC) > 1500/mm3 and platelet count > 100 000/ mm3;
- Hepatic: Total bilirubin < 1.5 mg/dl
- Renal: Creatinine < 1.5 mg/dl. or calculated
- Creatinine clearance > 45 ml/min (NB: Urine protein:creatinine ratio in exclusion criteria)
Eastern Cooperative Oncology Group (ECOG) performance status < 2
Be free of active infection.
Be available for active follow up.
No prior chemotherapy for metastatic disease.
Be disease free for > 5 years if they had a prior second malignancy other than treated basal cell carcinoma or squamous cell skin cancer, or carcinoma in situ of the cervix.
Female subject post-menopausal; surgically sterilized or willing to use an acceptable method of birth control for the duration of the study. Male subject agrees to use an acceptable method for contraception for the duration of the study.

Exclusion Criteria:

CNS or brain metastasis
Patient has = or greater Grade 2 peripheral neuropathy within 14 days before enrollment.
Known previous sensitivity reactions with boron, or mannitol,
Patients with known HIV positivity
Myocardial infarction within 6 months prior to enrollment or has New York Hospital Association (NYHA) Class III or IV heart failure, uncontrolled angina, severe uncontrolled ventricular arrhythmias, or electrocardiographic evidence of acute ischemia or active conduction system abnormalities. Any ECG abnormality at Screening has to be documented by the investigator as not medically relevant.
Blood pressure of >150/100 mmHG
History of myocardial infarction or stroke within 6 months
Clinically significant peripheral vascular disease
Major surgical procedure, open biopsy, or significant traumatic injury within 28 days prior to Day 0, anticipation of need for major surgical procedure during the course of the study.
Minor surgical procedure such as fine needle aspirations or core biopsies within 7 days prior to day 0
Urine protein: Creatinine ratio > 1.0 at screening
History of abdominal fistula, gastrointestinal perforation, or intraabdominal abscess within 6 months prior to Day 0
Serious, non-healing wound, ulcer, or bone fracture
Lung carcinoma or any histology in close proximity to a major vessel or cavitation
Female subject is pregnant or breast-feeding. Confirmation that the subject is not pregnant. Pregnancy testing is not required for post-menopausal or surgically sterilized women.
Patient has received other investigational drugs with 14 days before enrollment or is expected to participate in an experiment drug study during this study treatment.
Serious medical or psychiatric illness likely to interfere with participation in this clinical study.

Sites / Locations

University of Massachusetts Medical School

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Arm Label

Bortezomib 1.3 mg/m2

Bortezomib 1.6 mg/m2

Bortezomib 1.8 mg/m2

Arm Description

Level 1 of Bortezomib Dose Escalation in combination with Carboplatin AUC6, Bevacizumab 15 mg/kg and Taxotere 70 + G-CSF

Level 2 of Bortezomib Dose Escalation in combination with Carboplatin AUC6, Bevacizumab 15 mg/kg and Taxotere 70 + G-CSF

Level 3 of Bortezomib Dose Escalation in combination with Carboplatin AUC6, Bevacizumab 15 mg/kg and Taxotere 70 + G-CSF

Outcomes

Primary Outcome Measures

Number of Subjects Who Require Dose Delay/Reduction in Dose of Bortezomibin the First Cycle

Dose limiting toxicity at Level 1,2 and 3: Number of subjects who required dose delay/reduction in dose of bortezomib in the first cycle of treatment. DLT defined by any of the following during first cycle: (1) GR4 neutropenia or thrombocytopenia, (2) Greater than GR3 non-hematological toxicity except alopecia or inadequately treated nausea or vomiting or (3) neurosensory toxicity of GR2 with pain or any neurotoxicity greater than GR2.

Secondary Outcome Measures

Full Information

NCT ID

NCT00424840

First Posted

January 18, 2007

Last Updated

January 30, 2019

Sponsor

University of Massachusetts, Worcester

Collaborators

Millennium Pharmaceuticals, Inc., Genentech, Inc.

1. Study Identification

Unique Protocol Identification Number

NCT00424840

Brief Title

Phase I/II Study to Evaluate the Efficacy and Safety of a Combination Chemotherapy

Official Title

Phase I/II Study to Evaluate the Efficacy and Safety of Combination Chemotherapy With Carboplatin, Bortezomib and Bevacizumab as First Line Therapy in Patients With Advanced Non-small Cell Lung Cancer

Study Type

Interventional

2. Study Status

Record Verification Date

January 2019

Overall Recruitment Status

Terminated

Why Stopped

Poor accrual

Study Start Date

June 2006 (undefined)

Primary Completion Date

March 2014 (Actual)

Study Completion Date

March 2014 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title

Principal Investigator

Name of the Sponsor

University of Massachusetts, Worcester

Collaborators

Millennium Pharmaceuticals, Inc., Genentech, Inc.

4. Oversight

Studies a U.S. FDA-regulated Drug Product

Yes

Studies a U.S. FDA-regulated Device Product

Product Manufactured in and Exported from the U.S.

Yes

Data Monitoring Committee

5. Study Description

Brief Summary

A pilot trial of combination of bortezomib, bevacizumab and carboplatin as first line therapy in patients with metastatic Non-Small Cell Lung Cancer (NSCLC). Phase I and II study of this combination in first line setting will be conducted in order to properly estimate the efficacy and safety of this regimen. This will form the basis for future studies comparing this combination to what is now considered standard regimen for first line therapy in patients with NSCLC, carboplatin, paclitaxel and bevacizumab.

Detailed Description

Study design and methodology The study will have two phases. The phase I will use traditional dose escalation model (3-6 patient per dose level) to determine the maximum tolerated dose (MTD). *[In phase II, either level III or (MTD) will be used in the same every 21 day cycle to evaluate the efficacy and safety of the regimen in first line treatment of advanced NSCLC]* not conducted. Treatments administered In phase I, three dose levels of weekly bortezomib will be studied in conjunction with fixed dose carboplatin and bevacizumab on a 21 day cycle to define the maximum tolerated dose (MTD). A maximum of six cycles will be administered. Patients with complete response, partial response or stable disease after six cycles will be allowed to continue on single agent bevacizumab every 3 weeks as maintenance therapy until disease progression. If no dose limiting toxicity (DLT) is observed in 3 patients during the first cycle, the next dose level will be accrued. If 1 DLT is observed, 3 additional patients will be accrued to the dose level. If no additional DLTs are observed, the next dose level will be accrued. However, if 2 or more DLTs are observed in a given dose level, MTD will be defined. MTD will be defined as the dose below which ≥2 DLTs were observed. The following three levels will be studied: Level I (every 21 day cycle): D1: carboplatin AUC 6, bevacizumab 15 mg/kg, bortezomib 1.3 mg/m2 D8 : bortezomib 1.3 mg/m2 Level II (every 21 day cycle): D1: carboplatin AUC 6, bevacizumab 15 mg/kg, bortezomib 1.6 mg/m2 D8 : bortezomib 1.6 mg/m2 Level III(every 21 day cycle):D1: carboplatin AUC 6, bevacizumab 15 mg/kg, bortezomib 1.8 mg/m2 D8 : bortezomib 1.8 mg/m2 If 2 or more DLT are observed in Level 1, level -1 will be accrued. Level -1: (every 21 day cycle): D1: carboplatin AUC 6, bevacizumab 15 mg/kg, bortezomib 1 mg/m2 D8: bortezomib 1 mg/m2 *[In phase II, either level III or the MTD dose level will be used in the same every 21 day cycle to evaluate the efficacy and safety of the regimen in first line treatment of advanced NSCLC. Efficacy data collected The following evaluations will be conducted to assess the efficacy of the combination: response rate by Response Evaluation Criteria in Solid Tumors (RECIST) criteria disease free and overall survival, time to progress (TTP) and duration of response Safety data collected The following evaluations will be conducted to assess the safety of the combination chemotherapy: • toxicity based on National Cancer Institute-Common Terminology Criteria for Adverse Events (NCI-CTCAE) version 3.0]* Not conducted Statistical procedures In phase I portion, 9-18 patients will be enrolled. The patients treated at recommended dose level for phase II will also be eligible for response evaluation as part of phase II. *[The primary objective of the phase II study is to estimate the efficacy and safety of the combination therapy with carboplatin, bortezomib and bevacizumab as the first line therapy in patients with advanced NSCLC. The primary endpoints are response rate and progression-free survival (PFS). (NOT CONDUCTED) In phase II portion, the optimal two-stage design for phase II clinical trials described by Simon et al. will be utilized. Overall survival, progression free survival and time to progression will be estimated using Kaplan-Meier methods. Time to progression, progression free survival and survival will be calculated from the date of study entry.]* (Phase II not conducted.)

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study

Lung Cancer

Keywords

lung cancer, Carboplatin, bortezomib, Bevacizumab

7. Study Design

Primary Purpose

Treatment

Study Phase

Phase 1

Interventional Study Model

Single Group Assignment

Masking

None (Open Label)

Allocation

Non-Randomized

Enrollment

12 (Actual)

8. Arms, Groups, and Interventions

Arm Title

Bortezomib 1.3 mg/m2

Arm Type

Experimental

Arm Description

Level 1 of Bortezomib Dose Escalation in combination with Carboplatin AUC6, Bevacizumab 15 mg/kg and Taxotere 70 + G-CSF

Arm Title

Bortezomib 1.6 mg/m2

Arm Type

Experimental

Arm Description

Level 2 of Bortezomib Dose Escalation in combination with Carboplatin AUC6, Bevacizumab 15 mg/kg and Taxotere 70 + G-CSF

Arm Title

Bortezomib 1.8 mg/m2

Arm Type

Experimental

Arm Description

Level 3 of Bortezomib Dose Escalation in combination with Carboplatin AUC6, Bevacizumab 15 mg/kg and Taxotere 70 + G-CSF

Intervention Type

Drug

Intervention Name(s)

Bortezomib 1.3 mg/m2

Other Intervention Name(s)

Velcade

Intervention Description

Level I (every 21 day cycle, D8), 1.3 mg/m2: Day 1: bevacizumab 15 mg/kg ,carboplatin Area Under the Curve (AUC 6) 900mg, bortezomib 1.3 mg/m2 Day 8 : bortezomib 1.3 mg/m2 Level II (every 21 day cycle): Day 1: bevacizumab 15 mg/kg, carboplatin Area Under the Curve (AUC 6) 900mg, bortezomib 1.6 mg/m2 Day 8 : bortezomib 1.6 mg/m2 Level III(every 21 day cycle): Day 1: bevacizumab 15 mg/kg, carboplatin Area Under the Curve (AUC 6) 900mg, bortezomib 1.8 mg/m2 Day 8 : bortezomib 1.8 mg/m2

Intervention Type

Drug

Intervention Name(s)

Bortezomib 1.6 mg/m2

Other Intervention Name(s)

Velcade

Intervention Description

Level II (every 21 day cycle, D8), 1.6 mg/m2

Intervention Type

Drug

Intervention Name(s)

Bortezomib 1.8 mg/m2

Other Intervention Name(s)

Velcade

Intervention Description

Level III (every 21 day cycle, D8) 1.8 mg/m2

Intervention Type

Drug

Intervention Name(s)

Carboplatin AUC 6

Other Intervention Name(s)

Carboplatin

Intervention Description

Carboplatin AUC6

Intervention Type

Drug

Intervention Name(s)

Bevacizumab

Intervention Description

Bevacizumab 15 mg/kg

Intervention Type

Drug

Intervention Name(s)

Taxotere

Intervention Description

Taxotere 70 + G-CSF

Primary Outcome Measure Information:

Title

Number of Subjects Who Require Dose Delay/Reduction in Dose of Bortezomibin the First Cycle

Description

Time Frame

up to 21 days for each dosing cycle

10. Eligibility

Sex

All

Minimum Age & Unit of Time

18 Years

Accepts Healthy Volunteers

Eligibility Criteria

Inclusion Criteria: Histologically confirmed SCLC (adeno- and large cell, anaplastic carcinoma and broncho-alveolar-carcinoma). Patients with squamous-cell histology are eligible with extra thoracic or peripheral lung lesions only. Sputum cytology alone not acceptable evidence of cell type. Cytologic specimens obtained by brushing, washings, or needle aspiration of defined lesions will be acceptable. Mixed tumors will be categorized by the predominant cell type unless a small cell anaplastic elements are present, in which case the patient is ineligible. Stage III B because of pleural effusion or Stage IV disease Measurable disease. Age: 18 years or older No history of thrombotic, hemorrhagic, or coagulopathy disorders international normalized ratio (INR<1.5) and a prothrombin time (PTT) no greater than normal limits of normal within 1 week prior to registration. NB: subjects with lung cancer placed on anticoagulant therapy for a thrombotic event are not eligible for this study. No gross hemoptysis (defined as bright red blood of ½ teaspoon or more) No central nervous system (CNS) or brain metastasis Laboratory Criteria (completed <2 weeks before enrollment): Hematologic: white blood cell (WBC) > 3500/mm3 or absolute neutrophil count (ANC) > 1500/mm3 and platelet count > 100 000/ mm3; Hepatic: Total bilirubin < 1.5 mg/dl Renal: Creatinine < 1.5 mg/dl. or calculated Creatinine clearance > 45 ml/min (NB: Urine protein:creatinine ratio in exclusion criteria) Eastern Cooperative Oncology Group (ECOG) performance status < 2 Be free of active infection. Be available for active follow up. No prior chemotherapy for metastatic disease. Be disease free for > 5 years if they had a prior second malignancy other than treated basal cell carcinoma or squamous cell skin cancer, or carcinoma in situ of the cervix. Female subject post-menopausal; surgically sterilized or willing to use an acceptable method of birth control for the duration of the study. Male subject agrees to use an acceptable method for contraception for the duration of the study. Exclusion Criteria: CNS or brain metastasis Patient has = or greater Grade 2 peripheral neuropathy within 14 days before enrollment. Known previous sensitivity reactions with boron, or mannitol, Patients with known HIV positivity Myocardial infarction within 6 months prior to enrollment or has New York Hospital Association (NYHA) Class III or IV heart failure, uncontrolled angina, severe uncontrolled ventricular arrhythmias, or electrocardiographic evidence of acute ischemia or active conduction system abnormalities. Any ECG abnormality at Screening has to be documented by the investigator as not medically relevant. Blood pressure of >150/100 mmHG History of myocardial infarction or stroke within 6 months Clinically significant peripheral vascular disease Major surgical procedure, open biopsy, or significant traumatic injury within 28 days prior to Day 0, anticipation of need for major surgical procedure during the course of the study. Minor surgical procedure such as fine needle aspirations or core biopsies within 7 days prior to day 0 Urine protein: Creatinine ratio > 1.0 at screening History of abdominal fistula, gastrointestinal perforation, or intraabdominal abscess within 6 months prior to Day 0 Serious, non-healing wound, ulcer, or bone fracture Lung carcinoma or any histology in close proximity to a major vessel or cavitation Female subject is pregnant or breast-feeding. Confirmation that the subject is not pregnant. Pregnancy testing is not required for post-menopausal or surgically sterilized women. Patient has received other investigational drugs with 14 days before enrollment or is expected to participate in an experiment drug study during this study treatment. Serious medical or psychiatric illness likely to interfere with participation in this clinical study.

Overall Study Officials:

First Name & Middle Initial & Last Name & Degree

William Walsh, MD

Organizational Affiliation

University of MassachusettsMedical School

Official's Role

Principal Investigator

Facility Information:

Facility Name

University of Massachusetts Medical School

City

Worcester

State/Province

Massachusetts

ZIP/Postal Code

01655-0002

Country

United States

12. IPD Sharing Statement

Plan to Share IPD

Citations:

PubMed Identifier

2702835

Citation

Simon R. Optimal two-stage designs for phase II clinical trials. Control Clin Trials. 1989 Mar;10(1):1-10. doi: 10.1016/0197-2456(89)90015-9.

Results Reference

background

PubMed Identifier

17167137

Citation

Sandler A, Gray R, Perry MC, Brahmer J, Schiller JH, Dowlati A, Lilenbaum R, Johnson DH. Paclitaxel-carboplatin alone or with bevacizumab for non-small-cell lung cancer. N Engl J Med. 2006 Dec 14;355(24):2542-50. doi: 10.1056/NEJMoa061884. Erratum In: N Engl J Med. 2007 Jan 18;356(3):318.

Results Reference

background

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Phase I/II Study to Evaluate the Efficacy and Safety of a Combination Chemotherapy

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