Inhibition of CArbonic Anhydrase in Combination With Platinum and Etoposide-based Radiochemotherapy in Patients With Localized Small Cell Lung Cancer (ICAR)
Primary Purpose
Small Cell Lung Cancer
Status
Recruiting
Phase
Phase 1
Locations
France
Study Type
Interventional
Intervention
acetazolamide in combination with platinum and etoposide-based radiochemotherapy
Sponsored by
About this trial
This is an interventional treatment trial for Small Cell Lung Cancer
Eligibility Criteria
Inclusion Criteria:
- Age > or = 18 years,
- Performance Status 0 to 2,
- Patient with an histologically non-metastatic localized Small cell lung cancer,
- Patient who must start radiotherapy treatment combined with chemotherapy with platinum and etoposide, Note: The decision of the Multidisciplinary Consultation Team must be notified in the patient's medical file,
- Evaluation lesion according to the criteria RECIST 1.1 and / or according to the criteria PERCIST 1.0,
- Women of childbearing potential must have a negative serum pregnancy test within 72 hours of the first administration of the study treatment,
- If the patient is a woman of childbearing potential, she must be surgically sterile or agree to use two adequate methods of contraception throughout the duration of the study until 1 month after the last administration of the study treatment. Subjects of childbearing potential are those who have not been surgically sterilized or have not been free from menses for > 1 year, Note: Abstinence is acceptable if it is the patient's usual and preferred form of contraception,
- If the male patient has one or more female partners of childbearing age, he / she must agree to use an adequate method of contraception, starting at the first administration of the study treatment up to 1 month after the last administration of the treatment. of the study, Note: Abstinence is acceptable if it is the patient's usual and preferred form of contraception,
- Patient willing and able to provide written informed consent/assent for the trial,
- Patient affiliated with a health insurance system.
Exclusion Criteria:
- Patient with metastatic disease,
- History of thoracic irradiation or near / in the thoracic irradiation field,
- Patient who refuses to participate in the study or unable to agree,
Contraindication to thoracic radiotherapy treatment: congestive heart failure unbalanced (ejection fraction <30%, clinical signs), severe respiratory failure:
- COPD grade IV according to the GOLD classification,
- Some GOLD III COPD and any patient with a respiratory defect defined as: oxygen dependence and / or FEV1 <40% normal and / or, DLCO <40% predictive value and / or vital capacity <40% predictive value,
- Contraindication to acetazolamide: hypersensitivity to acetazolamide, severe hepatic, renal or adrenal insufficiency, sulfonamide intolerance, history of renal colic, allergy to wheat other than celiac disease,
- Patient currently receiving one or more treatments described in section 6.9 of the protocol,
- History of cancer, with the exception of cancers in complete remission for more than 5 years, completely resected basal cell carcinoma of the skin or squamous cell carcinoma of the skin that has undergone potentially curative therapy or in situ cervical cancer,
- People particularly vulnerable as defined in Articles L.1121-5 to -8 of the French Healthcare Code, including: person deprived of freedom by an administrative or judicial decision, adult being the object of a legal protection measure or outside a state to express their consent, pregnant or breastfeeding women
Sites / Locations
- Centre Antoine LacassagneRecruiting
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
One experimental arm
Arm Description
non randomized, open-label extension cohort, evaluating the safety of acetazolamide in combination with platinum and etoposide-based radiochemotherapy in patients with Localized small lung cancer
Outcomes
Primary Outcome Measures
To identify the Tolerated Maximum Dose (DMT) and Recommended Dose (DR) of acetazolamide in combination with radiotherapy combined with platinum and etoposide chemotherapy
The frequency of limiting dose toxicities determined by the number of Adverse Events as Assessed by CTCAE v4.03 during the 6 weeks of treatment with acetazolamide / chemoradiation based on platinum and etoposide and in the first 6 months of follow-up after the last administration of the treatment
Secondary Outcome Measures
To determine the overall tolerance of the association acetazolamide and radiochemotherapy
The overall tolerability of the association acetazolamide and radiochemotherapy during the duration of patient participation will be measured by clinical (performance status), laboratory (blood sample), and paraclinical evaluations (ETT, EFR) and defined on the NCI CTCAE V4.03 scale
To evaluate the effectiveness of the treatment
The tumor response (complete or partial, stabilization, progression) will be performed by Morphological evaluations using a scanner according to RECIST 1.1 criteria
To evaluate the effectiveness of the treatment
The tumor response (complete or partial, stabilization, progression) will be performed by Metabolic evaluations using a PET-CT scan according to the criteria PERCIST 1.0
To identify predictive factors for response to acetazolamide
The evaluation of predictive factors of acetazolamide response will be determined by:
o Initial serum CAIX and CAXII levels, in the 7 days before the start of chemoradiotherapy associated with acetazolamide and the end-of-treatment visit
To identify predictive factors for response to acetazolamide
The evaluation of predictive factors of acetazolamide response will be determined by:
o The initial 18-FDG PET-CT scan (SUVmax, SULpeak) fixation intensity and 3 months after treatment,
To evaluate progression-free survival at 24 months
To determine the delay between the date of inclusion and the date of progression or death
To evaluate overall survival at 24 months
To determine the delay between the date of inclusion and the date of death
To determine the compliance of acetazolamide
Compliance assessment will be done using Girerd's questionnaire
To evaluate the quality of life
Quality of life will be determined using EORTC QLQC30 questionnaire
Full Information
NCT ID
NCT03467360
First Posted
January 18, 2018
Last Updated
January 19, 2023
Sponsor
Centre Antoine Lacassagne
1. Study Identification
Unique Protocol Identification Number
NCT03467360
Brief Title
Inhibition of CArbonic Anhydrase in Combination With Platinum and Etoposide-based Radiochemotherapy in Patients With Localized Small Cell Lung Cancer
Acronym
ICAR
Official Title
Phase I Trial of Carbonic Anhydrase Inhibition Associated With Platinum-based Chemotherapy and Etoposide in Concomitance With Radiotherapy in Localized Small Cell Lung Carcinomas
Study Type
Interventional
2. Study Status
Record Verification Date
January 2023
Overall Recruitment Status
Recruiting
Study Start Date
August 2, 2019 (Actual)
Primary Completion Date
November 30, 2023 (Anticipated)
Study Completion Date
November 30, 2024 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Centre Antoine Lacassagne
4. Oversight
Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
The investigators propose to study the carbonic anhydrase inhibition (acetazolamide) associated with concomitant radiochemotherapy in localized small cell lung cancer due to:
The over-expression of carbonic anhydrases in this type of cancer,
The Anti-tumor effect in preclinical acetazolamide in various tumor lines including neuroendocrine tumor lines,
The observed synergy between irradiation and inhibition of carbonic anhydrases,
Potential anti-tumor immune effect caused by decreased extracellular acidity.
Detailed Description
Compared with healthy cells, glucose metabolism is greatly modified in cancer cells because of their highly proliferative character. This differential tumor / healthy tissue property is an opportunity to be able to propose a treatment whose therapeutic gain can be major (targeted treatment). Preclinical studies are multiple and showed that the targeting of overexpressed proteins (carbonic anhydrases) and involved in glycolytic metabolism can lead to a significant anti-tumor effect. This has never been tested in humans.
Acetazolamide is a molecule commonly used for non carcinologic purposes but has demonstrated anti-tumor activity in preclinical studies; there is also synergy radiotherapy / targeting of carbonic anhydrases. Therefore, the investigators propose to study the combination of acetazolamide / radiotherapy / chemotherapy with platinum and etoposide in localized Small Cell Lung cancer.
This would be the first study:
targeting glucose metabolism,
testing the effectiveness of acetazolamide in oncology,
testing the synergy radiotherapy / targeting glycolytic metabolism,
trying to manipulate the anti-tumor immune system indirectly, by decreasing extracellular acidosis.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Small Cell Lung Cancer
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Model Description
Phase I study with a prospective, multicenter, non randomized, open-label extension cohort, evaluating the safety of acetazolamide in combination with platinum and etoposide-based radiochemotherapy in patients with Localized Small cell lung cancer
Masking
None (Open Label)
Allocation
N/A
Enrollment
30 (Anticipated)
8. Arms, Groups, and Interventions
Arm Title
One experimental arm
Arm Type
Experimental
Arm Description
non randomized, open-label extension cohort, evaluating the safety of acetazolamide in combination with platinum and etoposide-based radiochemotherapy in patients with Localized small lung cancer
Intervention Type
Drug
Intervention Name(s)
acetazolamide in combination with platinum and etoposide-based radiochemotherapy
Intervention Description
Radiation therapy will be combined with platinum and etoposide-based chemotherapy combined with 3-6 tablets per day of acetazolamide during the entire course of therapy (dosage appropriate to the inclusion phase).
Primary Outcome Measure Information:
Title
To identify the Tolerated Maximum Dose (DMT) and Recommended Dose (DR) of acetazolamide in combination with radiotherapy combined with platinum and etoposide chemotherapy
Description
The frequency of limiting dose toxicities determined by the number of Adverse Events as Assessed by CTCAE v4.03 during the 6 weeks of treatment with acetazolamide / chemoradiation based on platinum and etoposide and in the first 6 months of follow-up after the last administration of the treatment
Time Frame
32 months
Secondary Outcome Measure Information:
Title
To determine the overall tolerance of the association acetazolamide and radiochemotherapy
Description
The overall tolerability of the association acetazolamide and radiochemotherapy during the duration of patient participation will be measured by clinical (performance status), laboratory (blood sample), and paraclinical evaluations (ETT, EFR) and defined on the NCI CTCAE V4.03 scale
Time Frame
27 months
Title
To evaluate the effectiveness of the treatment
Description
The tumor response (complete or partial, stabilization, progression) will be performed by Morphological evaluations using a scanner according to RECIST 1.1 criteria
Time Frame
24 months
Title
To evaluate the effectiveness of the treatment
Description
The tumor response (complete or partial, stabilization, progression) will be performed by Metabolic evaluations using a PET-CT scan according to the criteria PERCIST 1.0
Time Frame
24 months
Title
To identify predictive factors for response to acetazolamide
Description
The evaluation of predictive factors of acetazolamide response will be determined by:
o Initial serum CAIX and CAXII levels, in the 7 days before the start of chemoradiotherapy associated with acetazolamide and the end-of-treatment visit
Time Frame
30 months
Title
To identify predictive factors for response to acetazolamide
Description
The evaluation of predictive factors of acetazolamide response will be determined by:
o The initial 18-FDG PET-CT scan (SUVmax, SULpeak) fixation intensity and 3 months after treatment,
Time Frame
30 months
Title
To evaluate progression-free survival at 24 months
Description
To determine the delay between the date of inclusion and the date of progression or death
Time Frame
24 months
Title
To evaluate overall survival at 24 months
Description
To determine the delay between the date of inclusion and the date of death
Time Frame
24 months
Title
To determine the compliance of acetazolamide
Description
Compliance assessment will be done using Girerd's questionnaire
Time Frame
27 months
Title
To evaluate the quality of life
Description
Quality of life will be determined using EORTC QLQC30 questionnaire
Time Frame
27 months
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Age > or = 18 years,
Performance Status 0 to 2,
Patient with an histologically non-metastatic localized Small cell lung cancer,
Patient who must start radiotherapy treatment combined with chemotherapy with platinum and etoposide, Note: The decision of the Multidisciplinary Consultation Team must be notified in the patient's medical file,
Evaluation lesion according to the criteria RECIST 1.1 and / or according to the criteria PERCIST 1.0,
Women of childbearing potential must have a negative serum pregnancy test within 72 hours of the first administration of the study treatment,
If the patient is a woman of childbearing potential, she must be surgically sterile or agree to use two adequate methods of contraception throughout the duration of the study until 1 month after the last administration of the study treatment. Subjects of childbearing potential are those who have not been surgically sterilized or have not been free from menses for > 1 year, Note: Abstinence is acceptable if it is the patient's usual and preferred form of contraception,
If the male patient has one or more female partners of childbearing age, he / she must agree to use an adequate method of contraception, starting at the first administration of the study treatment up to 1 month after the last administration of the treatment. of the study, Note: Abstinence is acceptable if it is the patient's usual and preferred form of contraception,
Patient willing and able to provide written informed consent/assent for the trial,
Patient affiliated with a health insurance system.
Exclusion Criteria:
Patient with metastatic disease,
History of thoracic irradiation or near / in the thoracic irradiation field,
Patient who refuses to participate in the study or unable to agree,
Contraindication to thoracic radiotherapy treatment: congestive heart failure unbalanced (ejection fraction <30%, clinical signs), severe respiratory failure:
COPD grade IV according to the GOLD classification,
Some GOLD III COPD and any patient with a respiratory defect defined as: oxygen dependence and / or FEV1 <40% normal and / or, DLCO <40% predictive value and / or vital capacity <40% predictive value,
Contraindication to acetazolamide: hypersensitivity to acetazolamide, severe hepatic, renal or adrenal insufficiency, sulfonamide intolerance, history of renal colic, allergy to wheat other than celiac disease,
Patient currently receiving one or more treatments described in section 6.9 of the protocol,
History of cancer, with the exception of cancers in complete remission for more than 5 years, completely resected basal cell carcinoma of the skin or squamous cell carcinoma of the skin that has undergone potentially curative therapy or in situ cervical cancer,
People particularly vulnerable as defined in Articles L.1121-5 to -8 of the French Healthcare Code, including: person deprived of freedom by an administrative or judicial decision, adult being the object of a legal protection measure or outside a state to express their consent, pregnant or breastfeeding women
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Jérôme Doyen, MD
Phone
+33492031270
Email
jerome.doyen@nice.unicancer.fr
First Name & Middle Initial & Last Name or Official Title & Degree
Michel Poudenx, MD
Phone
+33492031129
Email
michel.poudenx@nice.unicancer.fr
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Christine Lovera
Organizational Affiliation
Centre Antoine Lacassagne
Official's Role
Study Chair
Facility Information:
Facility Name
Centre Antoine Lacassagne
City
Nice
ZIP/Postal Code
06189
Country
France
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Jérôme Doyen, MD
Phone
+33492031270
Email
jerome.doyen@nice.unicancer.fr
12. IPD Sharing Statement
Learn more about this trial
Inhibition of CArbonic Anhydrase in Combination With Platinum and Etoposide-based Radiochemotherapy in Patients With Localized Small Cell Lung Cancer
We'll reach out to this number within 24 hrs