Paclitaxel, Carboplatin, and Bevacizumab With or Without Cixutumumab in Treating Patients With Stage IV or Recurrent Non-small Cell Lung Cancer
Large Cell Lung Carcinoma, Lung Adenocarcinoma, Recurrent Non-Small Cell Lung Carcinoma
About this trial
This is an interventional treatment trial for Large Cell Lung Carcinoma focused on measuring Non-Small Cell Lung Cancer, cixutumumab
Eligibility Criteria
Inclusion Criteria:
- Histologically or cytologically confirmed with non-squamous, non-small cell lung cancer (NSCLC)
- Advanced NSCLC defined as either recurrent disease after prior radiation or surgery or stage IV (M1a or M1b) based on the TNM staging system (American Joint Committee on Cancer [AJCC] 2009)
- Measurable disease as defined by the revised Response Evaluation Criteria in Solid Tumors (RECIST version 1.1). All sites of disease (of target and non-target disease sites) must be obtained within 4 weeks prior to randomization
- A head computed tomography (CT) or magnetic resonance imaging (MRI) required within 4 weeks prior to randomization
- Prior radiation therapy (RT) is allowed if it has been completed 3 weeks prior to randomization and patient has recovered from any adverse events related to RT
- Brain metastases are allowed, provided they have been treated with surgery and/or radiotherapy, the patient is neurologically stable, and repeat brain imaging shows no progression in the brain; at least 6 weeks should have elapsed from the time of craniotomy and at least 4 weeks from radiotherapy
- Eastern Cooperative Oncology Group (ECOG) performance status 0-1
- Absolute neutrophil count (ANC) ≥ 1500/mm³
- Platelet count ≥ 100,000/mm³
- Total bilirubin within institutional upper limit of normal (ULN)
- Serum creatinine ≤ 1.5 x ULN
- Fasting blood glucose within normal range (fasting < 120 mg/dL or below ULN)
- Alkaline phosphatase (ALP) ≤ 3 x ULN
- Aspartate transaminase (AST) and alanine transaminase (ALT) ≤ 3 x ULN
- Urine dipstick must be ≤ 0-1+ within 2 weeks (14 days) of randomization; if urine dipstick result is > 1+, a calculation of urine protein creatinine (UPC) ratio is required; patients must have a UPC ratio < 1.0 to participate in the study
- Neuropathy, if present at baseline, must be ≤ Common Terminology Criteria for Adverse Events (CTCAE) grade 1
- Patients with a history of hypertension must be well-controlled (≤ 150/90) on a stable regimen of anti-hypertensive therapy
- Women of childbearing potential and sexually active males should use an accepted and effective method of contraception while on treatment and for 3 months thereafter
Exclusion Criteria:
- Prior chemotherapy or biologic/molecular targeted therapy for advanced NSCLC. Prior chemotherapy and/or biological/molecular targeted therapy as part of initial potentially curative therapy (one regimen of induction and/or adjuvant and/or concurrent chemoradiotherapy) was allowed provided it had been completed 1 year or more prior to randomization
- Prior treatment with IMC-A12 or another insulin-like growth factor 1 receptor (IGF-1R) inhibitor
- Patients on therapeutic anticoagulation; patient's international normalized ratio (INR) must be ≤ 1.5 or partial thromboplastin time (PTT) ≤ upper limits of normal within 2 weeks prior to randomization to be eligible; prophylactic anticoagulation of venous access devices is allowed provided the above criteria have been met
- Prior allergic reaction to compounds of chemical or biologic composition similar to those of IMC-A12
- Hypersensitivity to any component of bevacizumab
- Poorly controlled diabetes mellitus
- History of other invasive malignancies unless there is no active disease and all treatment has been completed ≥ 3 years prior to randomization; patients with history of in-situ malignancies and curatively resected nonmelanomatous skin cancer are eligible
- History of thrombotic or hemorrhagic disorders
- History of bleeding diathesis or coagulopathy
- ≥ grade 2 bleeding or any bleeding requiring intervention within 4 weeks prior to randomization
- History of gross hemoptysis (defined as ≥ 1/2 teaspoon of bright red blood)
Any of the following within 6 months prior to randomization:
- Abdominal fistula
- Gastrointestinal perforation
- Intra-abdominal abscess
- Previous myocardial infarction
- History of any central nervous system (CNS) cerebrovascular ischemia
- New York Heart Association (NYHA) > class II congestive heart failure or severe heart failure
- Unstable or symptomatic angina pectoris
- History of stroke
- Significant vascular disease
- Symptomatic peripheral vascular disease
- Ongoing, serious cardiac arrhythmia requiring medication at time of randomization
- Ongoing, active infection or ongoing fever at the time of randomization or any co-existing medical condition, psychiatric illness or limitations that would interfere with compliance of study requirements
- History of hypertensive crisis or hypertensive encephalopathy
- Any of the following within 4 weeks prior to randomization: a serious non-healing wound, ulcer, bone fracture, or major surgical procedure
- Anticipated major surgical procedure(s) during the course of the study
- Receiving daily treatment with aspirin (> 325 mg/day) or non-steroidal anti-inflammatory agents (NSAIDs) known to inhibit platelet function for chronic conditions; patients must not be receiving treatment with dipyridamole (Persantine), ticlopidine (Ticlid), clopidogrel (Plavix), and/or cilostazol (Pletal); if patient was receiving any of the following: aspirin (> 325 mg/day), NSAID, and/or anti-platelet drugs, patient must have discontinued its use ≥ 1 week prior to randomization
- Pregnant or breast-feeding
- Human immunodeficiency virus (HIV)-positive patients on combination antiretroviral therapy
Sites / Locations
- The Medical Center of Aurora
- Boulder Community Hospital
- Penrose-Saint Francis Healthcare
- Porter Adventist Hospital
- Presbyterian - Saint Lukes Medical Center - Health One
- SCL Health Saint Joseph Hospital
- Rose Medical Center
- Colorado Cancer Research Program NCORP
- Swedish Medical Center
- Saint Mary's Hospital and Regional Medical Center
- North Colorado Medical Center
- Saint Anthony Hospital
- Littleton Adventist Hospital
- Sky Ridge Medical Center
- Longmont United Hospital
- McKee Medical Center
- Saint Mary Corwin Medical Center
- North Suburban Medical Center
- SCL Health Lutheran Medical Center
- Smilow Cancer Hospital Care Center at Saint Francis
- The Hospital of Central Connecticut
- Eastern Connecticut Hematology and Oncology Associates
- Charlotte Hungerford Hospital Center for Cancer Care
- Lakeland Regional Cancer Center
- Lewis Cancer and Research Pavilion at Saint Joseph's/Candler
- Saint Alphonsus Cancer Care Center-Boise
- Saint Joseph Hospital
- Ingalls Memorial Hospital
- Hinsdale Hematology Oncology Associates Incorporated
- Swedish American Hospital
- SwedishAmerican Regional Cancer Center/ACT
- McFarland Clinic PC-William R Bliss Cancer Center
- Mercy Hospital
- Oncology Associates at Mercy Medical Center
- Medical Oncology and Hematology Associates-West Des Moines
- Mercy Cancer Center-West Lakes
- Iowa Methodist Medical Center
- Iowa-Wide Oncology Research Coalition NCORP
- Medical Oncology and Hematology Associates-Des Moines
- Medical Oncology and Hematology Associates-Laurel
- Mercy Medical Center - Des Moines
- Iowa Lutheran Hospital
- Ottumwa Regional Health Center
- Siouxland Regional Cancer Center
- Mercy Medical Center-Sioux City
- Saint Luke's Regional Medical Center
- Cancer Center of Kansas - Chanute
- Cancer Center of Kansas - Dodge City
- Cancer Center of Kansas - El Dorado
- Cancer Center of Kansas - Fort Scott
- Cancer Center of Kansas-Independence
- Cancer Center of Kansas-Kingman
- Lawrence Memorial Hospital
- Cancer Center of Kansas-Liberal
- Cancer Center of Kansas - McPherson
- Cancer Center of Kansas - Newton
- Cancer Center of Kansas - Parsons
- Cancer Center of Kansas - Pratt
- Cancer Center of Kansas - Salina
- Cancer Center of Kansas - Wellington
- Associates In Womens Health
- Cancer Center of Kansas-Wichita Medical Arts Tower
- Cancer Center of Kansas - Main Office
- Via Christi Regional Medical Center
- Wichita NCI Community Oncology Research Program
- Cancer Center of Kansas - Winfield
- Tufts Medical Center
- Saint Joseph Mercy Hospital
- Michigan Cancer Research Consortium CCOP
- Oakwood Hospital and Medical Center
- Saint John Hospital and Medical Center
- Hurley Medical Center
- Genesys Hurley Cancer Institute
- Genesys Regional Medical Center-West Flint Campus
- Allegiance Health
- Borgess Medical Center
- Bronson Methodist Hospital
- West Michigan Cancer Center
- Sparrow Hospital
- Saint Mary Mercy Hospital
- Saint Joseph Mercy Oakland
- Saint Joseph Mercy Port Huron
- Saint Mary's of Michigan
- Saint John Macomb-Oakland Hospital
- Sanford Clinic North-Bemidgi
- Essentia Health Saint Joseph's Medical Center
- Fairview Ridges Hospital
- Mercy Hospital
- Essentia Health Cancer Center
- Essentia Health Saint Mary's Medical Center
- Miller-Dwan Hospital
- Fairview-Southdale Hospital
- Unity Hospital
- Hutchinson Area Health Care
- Minnesota Oncology Hematology PA-Maplewood
- Saint John's Hospital - Healtheast
- Abbott-Northwestern Hospital
- Hennepin County Medical Center
- New Ulm Medical Center
- North Memorial Medical Health Center
- Metro Minnesota Community Oncology Research Consortium
- Park Nicollet Clinic - Saint Louis Park
- Regions Hospital
- United Hospital
- Saint Francis Regional Medical Center
- Lakeview Hospital
- Ridgeview Medical Center
- Rice Memorial Hospital
- Minnesota Oncology and Hematology PA-Woodbury
- Alegent Health Lakeside Hospital
- Veterans Adminstration New Jersey Health Care System
- Hunterdon Medical Center
- Rutgers New Jersey Medical School
- Roger Maris Cancer Center
- Sanford Clinic North-Fargo
- Sanford Medical Center-Fargo
- Summa Akron City Hospital/Cooper Cancer Center
- Mary Rutan Hospital
- Mercy Medical Center
- Adena Regional Medical Center
- The Christ Hospital
- Case Western Reserve University
- Riverside Methodist Hospital
- Columbus NCI Community Oncology Research Program
- Grant Medical Center
- Mount Carmel Health Center West
- Doctors Hospital
- Grady Memorial Hospital
- Fairfield Medical Center
- Saint Rita's Medical Center
- Marietta Memorial Hospital
- Knox Community Hospital
- Licking Memorial Hospital
- Southern Ohio Medical Center
- Springfield Regional Medical Center
- Genesis Healthcare System Cancer Care Center
- Bryn Mawr Hospital
- Geisinger Medical Center
- PinnacleHealth Cancer Center-Community Campus
- Geisinger Medical Center-Cancer Center Hazleton
- Saint Mary Medical and Regional Cancer Center
- Paoli Memorial Hospital
- University of Pennsylvania/Abramson Cancer Center
- Albert Einstein Medical Center
- University of Pittsburgh Cancer Institute (UPCI)
- Pottstown Memorial Medical Center
- Geisinger Medical Group
- Reading Hospital
- Geisinger Wyoming Valley/Henry Cancer Center
- Lankenau Medical Center
- Main Line Health NCORP
- Avera Cancer Institute
- Avera McKennan Hospital and University Health Center
- Dallas VA Medical Center
- Parkland Memorial Hospital
- UT Southwestern/Simmons Cancer Center-Dallas
- University of Texas Health Science Center at San Antonio
- West Virginia University Charleston
- Fox Valley Hematology and Oncology
- Marshfield Clinic Cancer Center at Sacred Heart
- Dean Hematology and Oncology Clinic
- Froedtert and the Medical College of Wisconsin
- Cancer Center of Western Wisconsin
- Oconomowoc Memorial Hospital-ProHealth Care Inc
- Waukesha Memorial Hospital
Arms of the Study
Arm 1
Arm 2
Active Comparator
Experimental
Arm A (CPB)
Arm B (CPB+cixutumumab)
Patients receive carboplatin intravenously (IV) over 30 minutes, paclitaxel IV over 3 hours, and bevacizumab IV over 30-90 minutes on day 1. Treatment repeats every 21 days for 6 courses in the absence of disease progression or unacceptable toxicity. Treatment with bevacizumab may continue in the absence of disease progression or unacceptable toxicity.
Patients receive carboplatin, paclitaxel, and bevacizumab as in Arm A. Patients also receive cixutumumab (IMC-A12) IV over 1 hour on days 1, 8, and 15. Treatment repeats every 21 days for 6 courses in the absence of disease progression or unacceptable toxicity. Treatment with bevacizumab and cixutumumab may continue in the absence of disease progression or unacceptable toxicity.