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Neoadjuvant Chemoradiotherapy With or Without Gefitinib in Treating Patients With Stage IIIA or Stage IIIB Non-Small Cell Lung Cancer

Primary Purpose

Lung Cancer

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
cisplatin
docetaxel
gefitinib
gemcitabine hydrochloride
conventional surgery
neoadjuvant therapy
radiation therapy
Sponsored by
University of Alabama at Birmingham
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

Eligibility Criteria

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

DISEASE CHARACTERISTICS: Histologically or cytologically confirmed non-small cell lung cancer Stage IIIA (T1-3, N2) Positive (pathological) ipsilateral mediastinal node Selective stage IIIB meeting all of the following criteria: No pleural/pericardial effusion or superior vena cava syndrome T4 due to invasion of carina, trachea, or mediastinal structures Mediastinal N3 nodes (without supraclavicular or cervical adenopathy) Proof of N2 or N3 status requires surgical staging of the mediastinum (mediastinoscopy, mediastinotomy, or exploration) Expression of epidermal growth factor receptor (at least 1+) by immunohistochemistry Measurable disease by contrast CT scan allowed No bronchoalveolar cell carcinoma No prior diagnosis of lung cancer PATIENT CHARACTERISTICS: Age 19 and over Performance status ECOG 0-1 (0-2 if albumin is at least 0.85 times lower limit of normal and weight loss within 3 months before diagnosis is no greater than 10%) Life expectancy Not specified Hematopoietic Absolute neutrophil count at least 1,500/mm^3 Platelet count at least 150,000/mm^3 Hemoglobin at least 10 g/dL Hepatic Bilirubin normal AST and ALT no greater than 2.5 times upper limit of normal (ULN) Alkaline phosphatase no greater than 2 times ULN Alkaline phosphatase between 1.5-2 times ULN requires a negative bone scan for metastatic bone disease Renal Creatinine no greater than 1.4 mg/dL OR Creatinine clearance at least 60 mL/min Cardiac No myocardial infarction within the past 3 months No active angina No unstable heart rhythms No congestive heart failure Pulmonary Post-resection predicted FEV_1% greater than 35% Predicted FEV_1% is defined as FEV_1% times percent perfusion to uninvolved lung from quantitative lung V/Q scan report Other Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception during and for at least 6 weeks after study treatment No other uncontrolled medical illness No other malignancy within the past 5 years except basal cell skin cancer or carcinoma in situ of the cervix No grade 2 or greater peripheral neuropathy No concurrent ocular inflammation or infection No prior severe hypersensitivity reaction to docetaxel or other drugs formulated with polysorbate 80 No known severe hypersensitivity reaction to gefitinib or any of its excipients No prior severe allergic reaction to platinum-containing compounds or mannitol PRIOR CONCURRENT THERAPY: Biologic therapy No concurrent growth factors (e.g., filgrastim [G-CSF] or sargramostim [GM-CSF]) during chemotherapy Chemotherapy No prior chemotherapy for lung cancer Endocrine therapy Not specified Radiotherapy No prior radiotherapy for lung cancer Surgery Recovered from prior major surgery No concurrent ophthalmic surgery Other More than 30 days since prior unapproved or investigational drugs No concurrent use of the following drugs: Phenytoin Carbamazepine Barbiturates Rifampin Phenobarbital Hypericum perforatum (St. John's Wort) Warfarin No concurrent retinoids

Sites / Locations

  • University of Alabama at Birmingham Comprehensive Cancer Center

Outcomes

Primary Outcome Measures

Determine the tolerability and toxicity of gefitinib in combination with chest radiotherapy in patients with stage IIIA or stage IIIB non-small cell lung cancer.

Secondary Outcome Measures

Full Information

First Posted
June 5, 2003
Last Updated
October 6, 2015
Sponsor
University of Alabama at Birmingham
Collaborators
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT00062270
Brief Title
Neoadjuvant Chemoradiotherapy With or Without Gefitinib in Treating Patients With Stage IIIA or Stage IIIB Non-Small Cell Lung Cancer
Official Title
Neoadjuvant Chemoradiotherapy (Gemcitabine/Cisplatin and Taxotere) With or Without Co-Administration of ZD 1839 (Iressa) for Stage IIIA (N2) and Selective Stage IIIB Non-Small Cell Lung Cancer: Phase I-II Study
Study Type
Interventional

2. Study Status

Record Verification Date
September 2015
Overall Recruitment Status
Completed
Study Start Date
May 2003 (undefined)
Primary Completion Date
September 2004 (Actual)
Study Completion Date
September 2004 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of Alabama at Birmingham
Collaborators
National Cancer Institute (NCI)

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Radiation therapy uses high-energy x-rays to damage tumor cells. Biological therapies such as gefitinib may interfere with the growth of the tumor cells and slow the growth of the tumor. Combining chemotherapy and radiation therapy with gefitinib before surgery may shrink the tumor so that it can be removed during surgery. PURPOSE: Phase I/II trial to compare the effectiveness of neoadjuvant chemoradiotherapy with or without gefitinib in treating patients who are undergoing surgery for stage III non-small cell lung cancer.
Detailed Description
OBJECTIVES: Phase I: Determine the tolerability and toxicity of gefitinib in combination with chest radiotherapy in patients with stage IIIA or stage IIIB non-small cell lung cancer. Phase II: Compare the pathologic response (complete response and rate of downstaging) in patients treated with neoadjuvant chemoradiotherapy with vs without gefitinib. Compare the feasibility and toxicity profile of these regimens in these patients. Compare the resection rates, time to progression, and overall survival of patients treated with these regimens. Correlate the percent decline in the fludeoxyglucose F 18 standardized uptake value as measured by position emission tomography with pathologic response at resection, time to progression, and overall survival in patients treated with these regimens. OUTLINE: Phase I: This is an open-label, nonrandomized study. Induction: Patients receive cisplatin IV over 60 minutes on day 1 and gemcitabine IV over 30 minutes on days 1 and 8. Treatment repeats every 3 weeks for a total of 2 courses in the absence of disease progression or unacceptable toxicity. Consolidation: Within 3-4 weeks after the completion of induction therapy, patients undergo radiotherapy once daily 5 days a week for 5 weeks and receive oral gefitinib once daily concurrently. A cohort of 3-6 patients receives consolidation chemoradiotherapy. If 2 of 6 patients experience dose-limiting toxicity, gefitinib is deleted from consolidation therapy in phase II arm II. Surgery: Patients without disease progression after consolidation therapy undergo thoracotomy within 3-5 weeks after consolidation. Maintenance: Beginning 2-4 weeks after surgery, patients receive oral gefitinib once daily for 6 months in the absence of disease progression. Phase II: This is a randomized study. Patients are randomized to 1 of 2 treatment arms. Arm I: Patients receive induction and consolidation therapy (with the exception of gefitinib) as in phase I. Patients also receive docetaxel IV over 60 minutes concurrently with radiotherapy during consolidation. Patients undergo surgery as in phase I. Arm II: Patients receive therapy (including gefitinib) as in phase I. Patients also receive docetaxel IV over 60 minutes concurrently with radiotherapy during consolidation. Patients are followed every 6-8 weeks for the first 12 months and then every 4-6 months thereafter. PROJECTED ACCRUAL: A total of 43-80 patients (3-6 patients for phase I and 40-74 patients [20-37 per treatment arm] for phase II) will be accrued for 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

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Masking
None (Open Label)
Allocation
Randomized

8. Arms, Groups, and Interventions

Intervention Type
Drug
Intervention Name(s)
cisplatin
Intervention Type
Drug
Intervention Name(s)
docetaxel
Intervention Type
Drug
Intervention Name(s)
gefitinib
Intervention Type
Drug
Intervention Name(s)
gemcitabine hydrochloride
Intervention Type
Procedure
Intervention Name(s)
conventional surgery
Intervention Type
Procedure
Intervention Name(s)
neoadjuvant therapy
Intervention Type
Radiation
Intervention Name(s)
radiation therapy
Primary Outcome Measure Information:
Title
Determine the tolerability and toxicity of gefitinib in combination with chest radiotherapy in patients with stage IIIA or stage IIIB non-small cell lung cancer.

10. Eligibility

Sex
All
Minimum Age & Unit of Time
19 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 Stage IIIA (T1-3, N2) Positive (pathological) ipsilateral mediastinal node Selective stage IIIB meeting all of the following criteria: No pleural/pericardial effusion or superior vena cava syndrome T4 due to invasion of carina, trachea, or mediastinal structures Mediastinal N3 nodes (without supraclavicular or cervical adenopathy) Proof of N2 or N3 status requires surgical staging of the mediastinum (mediastinoscopy, mediastinotomy, or exploration) Expression of epidermal growth factor receptor (at least 1+) by immunohistochemistry Measurable disease by contrast CT scan allowed No bronchoalveolar cell carcinoma No prior diagnosis of lung cancer PATIENT CHARACTERISTICS: Age 19 and over Performance status ECOG 0-1 (0-2 if albumin is at least 0.85 times lower limit of normal and weight loss within 3 months before diagnosis is no greater than 10%) Life expectancy Not specified Hematopoietic Absolute neutrophil count at least 1,500/mm^3 Platelet count at least 150,000/mm^3 Hemoglobin at least 10 g/dL Hepatic Bilirubin normal AST and ALT no greater than 2.5 times upper limit of normal (ULN) Alkaline phosphatase no greater than 2 times ULN Alkaline phosphatase between 1.5-2 times ULN requires a negative bone scan for metastatic bone disease Renal Creatinine no greater than 1.4 mg/dL OR Creatinine clearance at least 60 mL/min Cardiac No myocardial infarction within the past 3 months No active angina No unstable heart rhythms No congestive heart failure Pulmonary Post-resection predicted FEV_1% greater than 35% Predicted FEV_1% is defined as FEV_1% times percent perfusion to uninvolved lung from quantitative lung V/Q scan report Other Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception during and for at least 6 weeks after study treatment No other uncontrolled medical illness No other malignancy within the past 5 years except basal cell skin cancer or carcinoma in situ of the cervix No grade 2 or greater peripheral neuropathy No concurrent ocular inflammation or infection No prior severe hypersensitivity reaction to docetaxel or other drugs formulated with polysorbate 80 No known severe hypersensitivity reaction to gefitinib or any of its excipients No prior severe allergic reaction to platinum-containing compounds or mannitol PRIOR CONCURRENT THERAPY: Biologic therapy No concurrent growth factors (e.g., filgrastim [G-CSF] or sargramostim [GM-CSF]) during chemotherapy Chemotherapy No prior chemotherapy for lung cancer Endocrine therapy Not specified Radiotherapy No prior radiotherapy for lung cancer Surgery Recovered from prior major surgery No concurrent ophthalmic surgery Other More than 30 days since prior unapproved or investigational drugs No concurrent use of the following drugs: Phenytoin Carbamazepine Barbiturates Rifampin Phenobarbital Hypericum perforatum (St. John's Wort) Warfarin No concurrent retinoids
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Francisco Robert, MD, FACP
Organizational Affiliation
University of Alabama at Birmingham
Official's Role
Study Chair
Facility Information:
Facility Name
University of Alabama at Birmingham Comprehensive Cancer Center
City
Birmingham
State/Province
Alabama
ZIP/Postal Code
35294-3300
Country
United States

12. IPD Sharing Statement

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Neoadjuvant Chemoradiotherapy With or Without Gefitinib in Treating Patients With Stage IIIA or Stage IIIB Non-Small Cell Lung Cancer

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