Carboplatin and Paclitaxel Combined With Cetuximab and/or IMC-A12 in Patients With Advanced Non-Small Cell Lung Cancer
Recurrent Non-small Cell Lung Cancer, Stage IIIB Non-small Cell Lung Cancer, Stage IV Non-small Cell Lung Cancer

About this trial
This is an interventional treatment trial for Recurrent Non-small Cell Lung Cancer focused on measuring Advanced Non-small Cell Lung Cancer, Carboplatin, Paclitaxel, Cetuximab, IMC-A12
Eligibility Criteria
Inclusion Criteria:
Histologically or cytologically confirmed non-small cell lung cancer (NSCLC)
Stage IIIB disease
- T4, NX with nodule in ipsilateral lung lobe allowed provided patient is not a candidate for combined chemotherapy and radiotherapy
- Stage IV disease (includes M1a and M1b)
- Measurable disease as defined by Response Evaluation Criteria in Solid Tumors (RECIST) criteria
- Ineligible for or refused treatment with bevacizumab
No untreated or symptomatic central nervous system (CNS) metastases
Patients with a history of CNS metastases that are definitively treated, stable, and controlled are eligible provided the following criteria are met:
- Definitive therapy (surgery and/or radiotherapy) has been administered
- Not planning to undergo additional treatment for brain metastases
- Clinically stable
- Off corticosteroids or on a stable dose of corticosteroids for ≥ 14 days before study entry
- ECOG performance status 0-1
- Leukocytes > 3,000/mm^3
- Absolute neutrophil count (ANC) > 1,500/mm^3
- Hemoglobin > 9 g/dL
- Platelet count > 100,000/mm^3
- Total bilirubin ≤ 1.5 times upper limit of normal (ULN)
- Aspartate Aminotransferase (AST) < 3 times ULN (< 5 times ULN if elevations due to liver metastases)
- Creatinine < 1.5 times ULN OR creatinine clearance > 60 mL/min
- Fasting serum glucose < 120 mg/dL
- Partial thromboplastin time (PTT) ≤ 1.2 times ULN and international normalized ratio (INR) ≤ 1.5 (unless patient is on anticoagulation therapy)
- Negative pregnancy test
- Fertile patients must use effective contraception during and for 3 months after the last dose of cixutumumab
No poorly controlled diabetes mellitus
- Patients with a history of diabetes mellitus are eligible provided their blood glucose is within normal range and they are on a stable dietary or therapeutic regimen for this condition
No other prior or concurrent malignancy, except for the following:
- Curatively treated malignancy with no known active disease for ≥ 3 years AND is considered to be at low risk for recurrence by the treating physician
- Adequately treated nonmelanoma skin cancer or lentigo maligna with no evidence of disease
- Adequately treated cervical carcinoma in situ with no evidence of disease
- Prostatic intraepithelial neoplasia with no evidence of prostate cancer
- Concurrent therapeutic anticoagulation allowed provided there is no bleeding and patient is on a stable dose of anticoagulation therapy (e.g., Warfarin with an INR of 2-3) for > 2 weeks prior to study entry
- At least 21 days since prior radiotherapy
- More than 4 weeks since prior major surgery or hormonal therapy (other than hormone replacement therapy) and recovered
- More than 1 year since prior neoadjuvant or adjuvant chemotherapy
Exclusion criteria:
- Small cell lung cancer or mixed small cell and NSCLC
- History of allergic reactions attributed to compounds of similar chemical or biological composition to cixutumumab
- History of any medical or psychiatric condition, addictive disorder, or laboratory abnormality that, in the opinion of the investigator, may increase the risks associated with study participation or study treatments or may interfere with the conduct of the study or interpretation of study results
- Prior agents targeting the EGFR or Insulin-like growth factor (IGFR) pathways
- Prior therapy for advanced NSCLC, except for surgery and/or radiotherapy
- Prior systemic therapy, including bevacizumab for advanced stage NSCLC
- Pregnant or nursing
- Peripheral neuropathy > grade 1 as per Common Terminology Criteria for Adverse Event (CTCAE) v 4.0
- History of or suspected interstitial pneumonitis or pulmonary fibrosis on imaging
Significant uncontrolled cardiac disease within the past 6 months, including any of the following:
- Uncontrolled hypertension (BP > 150/100 mm Hg)
- Unstable angina
- Recent myocardial infarction
- Uncontrolled congestive heart failure
- Cardiomyopathy with decreased ejection fraction
- Arterial thrombosis, pulmonary embolus, deep vein thrombosis, or hemorrhagic disorders within the past 28 days
Sites / Locations
- Stanford University Hospitals and Clinics
- The Medical Center of Aurora
- Boulder Community Hospital
- Penrose-Saint Francis Healthcare
- Porter Adventist Hospital
- Exempla Saint Joseph Hospital
- Presbyterian - Saint Lukes Medical Center - Health One
- Rose Medical Center
- Colorado Cancer Research Program CCOP
- Swedish Medical Center
- Saint Mary's Hospital and Regional Medical Center
- North Colorado Medical Center
- Saint Anthony Hospital
- Sky Ridge Medical Center
- Longmont United Hospital
- McKee Medical Center
- Saint Mary Corwin Medical Center
- North Suburban Medical Center
- Exempla Lutheran Medical Center
- Danbury Hospital
- Saint Francis Hospital and Medical Center
- Manchester Memorial Hospital
- Medical Center of Central Georgia
- Illinois CancerCare-Bloomington
- Saint Joseph Medical Center
- Graham Hospital Association
- Illinois CancerCare-Canton
- Illinois CancerCare-Carthage
- Memorial Hospital
- Eureka Hospital
- Illinois CancerCare-Eureka
- Evanston CCOP-NorthShore University HealthSystem
- Illinois CancerCare Galesburg
- Illinois CancerCare-Havana
- Mason District Hospital
- Hinsdale Hematology Oncology Associates Incorporated
- Illinois CancerCare-Kewanee Clinic
- Illinois CancerCare-Macomb
- Mcdonough District Hospital
- Garneau, Stewart C MD (UIA Investigator)
- Porubcin, Michael MD (UIA Investigator)
- Sharis, Christine M MD (UIA Investigator)
- Spector, David MD (UIA Investigator)
- Stoffel, Thomas J MD (UIA Investigator)
- Trinity Medical Center
- Holy Family Medical Center
- Illinois CancerCare-Monmouth
- Bromenn Regional Medical Center
- Community Cancer Center Foundation
- Illinois CancerCare-Community Cancer Center
- Illinois CancerCare-Ottawa Clinic
- Ottawa Regional Hospital and Healthcare Center
- Pekin Cancer Treatment Center
- Pekin Hospital
- Illinois CancerCare-Pekin
- Methodist Medical Center of Illinois
- Proctor Hospital
- Illinois CancerCare-Peoria
- Illinois Oncology Research Association CCOP
- OSF Saint Francis Medical Center
- Illinois CancerCare-Peru
- Illinois Valley Hospital
- Illinois CancerCare-Princeton
- Perry Memorial Hospital
- Illinois CancerCare-Spring Valley
- Saint Margaret's Hospital
- Elkhart General Hospital
- Indiana University Medical Center
- Richard L. Roudebush Veterans Affairs Medical Center
- Wishard Hospital
- Community Howard Regional Health
- Indiana University Health La Porte Hospital
- IU Health Arnett
- Saint Joseph Regional Medical Center-Mishawaka
- Memorial Hospital of South Bend
- Northern Indiana Cancer Research Consortium
- Constantinou, Costas L MD (UIA Investigator)
- Cedar Rapids Oncology Association
- Mercy Hospital
- Oncology Associates at Mercy Medical Center
- Siouxland Hematology Oncology Associates
- 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 - 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 CCOP
- Cancer Center of Kansas - Winfield
- Greater Baltimore Medical Center
- Bixby Medical Center
- Hickman Cancer Center
- Saint Joseph Mercy Hospital
- Michigan Cancer Research Consortium Community Clinical Oncology Program
- Oakwood Hospital
- Saint John Hospital and Medical Center
- Green Bay Oncology - Escanaba
- Hurley Medical Center
- Genesys Regional Medical Center-West Flint Campus
- Green Bay Oncology - Iron Mountain
- Allegiance Health
- Borgess Medical Center
- Bronson Methodist Hospital
- West Michigan Cancer Center
- Sparrow Hospital
- Saint Mary Mercy Hospital
- Community Cancer Center of Monroe
- Mercy Memorial Hospital
- Saint Joseph Mercy Oakland
- Saint Joseph Mercy Port Huron
- Saint Mary's of Michigan
- Marie Yeager Cancer Center
- Lakeland Hospital
- Saint John Macomb-Oakland Hospital
- Fairview Ridges Hospital
- Mercy Hospital
- Essentia Health Duluth Clinic CCOP
- Essentia Health Saint Mary's Medical Center
- Miller-Dwan Hospital
- Fairview-Southdale Hospital
- Unity Hospital
- Minnesota Oncology Hematology PA-Maplewood
- Saint John's Hospital - Healtheast
- Abbott-Northwestern Hospital
- North Memorial Medical Health Center
- Metro-Minnesota CCOP
- Park Nicollet Clinic - Saint Louis Park
- United Hospital
- Saint Francis Regional Medical Center
- Ridgeview Medical Center
- Rice Memorial Hospital
- Minnesota Oncology and Hematology PA-Woodbury
- Nebraska Cancer Research Center
- Missouri Valley Cancer Consortium CCOP
- Alegent Health Immanuel Medical Center
- Alegent Health Bergan Mercy Medical Center
- Creighton University Medical Center
- University Medical Center of Southern Nevada
- Nevada Cancer Research Foundation CCOP
- Hunterdon Medical Center
- Fox Chase Cancer Center at Virtua Memorial Hospital of Burlington County
- Newark Beth Israel Medical Center
- Virtua West Jersey Hospital Voorhees
- New York Oncology Hematology PC - Albany
- New York Oncology Hematology PC -Albany Medical Center
- New York Oncology Hematology PC - Amsterdam
- New York Oncology Hematology PC-Hudson
- New York Oncology Hematology PC - Latham
- New York Oncology Hematology PC - Rexford
- New York Oncology Hematology PC - Troy
- Summa Akron City Hospital/Cooper Cancer Center
- Mary Rutan Hospital
- Toledo Clinic Cancer Centers-Bowling Green
- Adena Regional Medical Center
- Case Western Reserve University
- North Coast Cancer Care-Clyde
- Riverside Methodist Hospital
- Columbus CCOP
- Grant Medical Center
- Mount Carmel Health Center West
- Doctors Hospital
- Grady Memorial Hospital
- Hematology Oncology Center Incorporated
- Fairfield Medical Center
- Lima Memorial Hospital
- Marietta Memorial Hospital
- Saint Luke's Hospital
- Toledo Clinic Cancer Centers-Maumee
- Toledo Radiation Oncology at Northwest Ohio Onocolgy Center
- Knox Community Hospital
- Licking Memorial Hospital
- Fisher-Titus Medical Center
- UHHS-Chagrin Highlands Medical Center
- Saint Charles Hospital
- Toledo Clinic Cancer Centers-Oregon
- North Coast Cancer Care
- Springfield Regional Medical Center
- Flower Hospital
- Mercy Hospital of Tiffin
- The Toledo Hospital/Toledo Children's Hospital
- Saint Vincent Mercy Medical Center
- University of Toledo
- Toledo Community Hospital Oncology Program CCOP
- Mercy Saint Anne Hospital
- Toledo Clinic Cancer Centers-Toledo
- Fulton County Health Center
- Saint Ann's Hospital
- UHHS-Westlake Medical Center
- Genesis HealthCare System
- Natalie Warren Bryant Cancer Center at Saint Francis
- Bryn Mawr Hospital
- Geisinger Medical Center
- Geisinger Medical Center-Cancer Center Hazelton
- Lancaster General Hospital
- Paoli Memorial Hospital
- Abramson Cancer Center of The University of Pennsylvania
- Albert Einstein Medical Center
- University of Pittsburgh
- Pottstown Memorial Medical Center
- Mercy Hospital
- Scranton Hematology Oncology
- Geisinger Medical Group
- Geisinger Wyoming Valley
- Lankenau Hospital
- Mainline Health CCOP
- Vanderbilt-Ingram Cancer Center Cool Springs
- Nashville Oncology Associates PC
- Scott and White Memorial Hospital
- University of Virginia
- Fredericksburg Oncology Inc
- West Virginia University Charleston
- Wheeling Hospital
- Fox Valley Hematology and Oncology
- Marshfield Clinic-Chippewa Center
- Marshfield Clinic Cancer Center at Sacred Heart
- Green Bay Oncology at Saint Vincent Hospital
- Saint Vincent Hospital
- Green Bay Oncology Limited at Saint Mary's Hospital
- Saint Mary's Hospital
- UW Cancer Center Johnson Creek
- Gundersen Lutheran
- UW Health Oncology - 1 South Park
- University of Wisconsin Hospital and Clinics
- Holy Family Memorial Hospital
- Bay Area Medical Center
- Marshfield Clinic
- Marshfield Clinic-Minocqua Center
- Green Bay Oncology - Oconto Falls
- Marshfield Clinic at James Beck Cancer Center
- Marshfield Clinic-Rice Lake Center
- Marshfield Clinic Cancer Care at Saint Michael's Hospital
- Green Bay Oncology - Sturgeon Bay
- Marshfield Clinic-Wausau Center
- Marshfield Clinic - Weston Center
- Marshfield Clinic - Wisconsin Rapids Center
- Riverview Hospital
Arms of the Study
Arm 1
Arm 2
Arm 3
Experimental
Experimental
Experimental
Arm I (carboplatin, paclitaxel, cetuximab)
Arm II (carboplatin, paclitaxel, cixutumumab)
Arm III (carboplatin, paclitaxel, cetuximab, cixutumumab)
Patients receive carboplatin IV over 15-30 minutes and paclitaxel IV over 3 hours on days 1 and 22 and cetuximab IV over 1-2 hours on days 1, 8, 15, 22, 29, and 36. Treatment repeats every 42 days for 2 courses. Patients with stable or responding disease after 2 courses proceed to maintenance therapy with cetuximab alone on days 1, 8, 15, 22, 29, and 36. Treatment with cetuximab repeats every 42 days in the absence of disease progression or unacceptable toxicity.
Patients receive carboplatin and paclitaxel as in arm I. Patients also receive cixutumumab IV over 1 hour on days 1, 15, and 29. Treatment repeats every 42 days for 2 courses. Patients with stable or responding disease after 2 courses proceed to maintenance therapy with cixutumumab alone on days 1, 15, and 29. Treatment with cixutumumab repeats every 42 days in the absence of disease progression or unacceptable toxicity.
Patients receive carboplatin, paclitaxel, and cetuximab as in arm I. Patients also receive cixutumumab as in arm II. Treatment repeats every 42 days for 2 courses. Patients with stable or responding disease after 2 courses proceed to maintenance therapy with cetuximab as in arm I and cixutumumab as in arm II.