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Radiation Therapy Combined With Either Gefitinib or Temozolomide in Pats With NSCLC and Brain Metastases

Primary Purpose

Lung Cancer, Metastatic Cancer

Status
Completed
Phase
Phase 2
Locations
Switzerland
Study Type
Interventional
Intervention
gefitinib
temozolomide
radiation therapy
Sponsored by
Swiss Group for Clinical Cancer Research
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Lung Cancer focused on measuring stage IV non-small cell lung cancer, recurrent non-small cell lung cancer, tumors metastatic to brain

Eligibility Criteria

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

DISEASE CHARACTERISTICS: Histologically or cytologically confirmed non-small cell lung cancer AND newly diagnosed brain metastases meeting 1 of the following criteria: Multiple brain metastases Single brain metastasis not amenable to potentially curative treatment No advanced extracranial disease severely compromising vital functions and performance PATIENT CHARACTERISTICS: Age 18 and over Performance status WHO 0-2 Life expectancy Not specified Hematopoietic Hemoglobin > 10 g/dL Absolute neutrophil count > 1,500/mm^3 Platelet count > 100,000/mm^3 Hepatic Bilirubin ≤ 1.5 times upper limit of normal (ULN) AST and ALT ≤ 2.5 times ULN Alkaline phosphatase ≤ 2.5 times ULN (5 times ULN in the presence of documented bone metastases) No unstable or uncompensated hepatic disease that would preclude study participation Renal Creatinine clearance ≥ 40 mL/min No unstable or uncompensated renal disease that would preclude study participation Cardiovascular No myocardial infarction within the past 3 months No unstable or uncompensated cardiac disease that would preclude study participation Pulmonary No clinically active interstitial lung disease Patients with chronic stable radiographic changes who are asymptomatic eligible No other unstable or uncompensated respiratory disease that would preclude study participation Other Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception during and for 12 months after completion of study treatment No nausea, vomiting, inability to swallow whole tablets/capsules, or malabsorption syndrome that would preclude oral medication ingestion or absorption No psychiatric disorder that would preclude giving informed consent or study compliance No active infection No uncontrolled diabetes mellitus No other medical condition that would preclude study participation PRIOR CONCURRENT THERAPY: Biologic therapy Not specified Chemotherapy No prior temozolomide Endocrine therapy Concurrent corticosteroids allowed provided dose has been stable or decreasing for ≥ 4 days before study entry Radiotherapy No prior brain irradiation Surgery Not specified Other No prior gefitinib or erlotinib More than 30 days since prior investigational clinical trial participation No other concurrent experimental drugs No other concurrent anticancer therapy No concurrent treatment with any of the following: Phenytoin Carbamazepine Rifampin Barbiturates Hypericum perforatum (St. John's wort) Other enzyme-inducing anti-epileptic drugs or tuberculostatic treatments Any drug that contraindicates administration with study drugs

Sites / Locations

  • Oncology Institute of Southern Switzerland
  • Kantonsspital Graubuenden
  • Centre Hospitalier Universitaire Vaudois

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Active Comparator

Arm Label

Arm I

Arm II

Arm Description

Patients undergo whole-brain radiotherapy (WBRT) once daily on days 1-5 and 8-12 and receive oral gefitinib once daily on days 1-28. Gefitinib treatment repeats every 28 days in the absence of disease progression or unacceptable toxicity

Patients undergo WBRT as in arm I and receive oral temozolomide once daily on days 1-21. Temozolomide treatment repeats every 28 days in the absence of disease progression or unacceptable toxicity

Outcomes

Primary Outcome Measures

Overall survival

Secondary Outcome Measures

Time to progression
Time to neurological progression
Time to extracranial disease progression
Adverse events as measured at completion of study treatment

Full Information

First Posted
October 12, 2005
Last Updated
June 4, 2012
Sponsor
Swiss Group for Clinical Cancer Research
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1. Study Identification

Unique Protocol Identification Number
NCT00238251
Brief Title
Radiation Therapy Combined With Either Gefitinib or Temozolomide in Pats With NSCLC and Brain Metastases
Official Title
Whole Brain Radiotherapy in Combination With Gefitinib (Iressa) or Temozolomide (Temodal) for Brain Metastases From Non-Small Lung Cancer (NSCLC) A Randomized Phase II Trial
Study Type
Interventional

2. Study Status

Record Verification Date
June 2012
Overall Recruitment Status
Completed
Study Start Date
May 2005 (undefined)
Primary Completion Date
April 2009 (Actual)
Study Completion Date
November 2010 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Swiss Group for Clinical Cancer Research

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
RATIONALE: Radiation therapy uses high-energy x-rays to kill tumor cells. Gefitinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy, such as temozolomide, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Giving radiation therapy together with either gefitinib or temozolomide may kill more tumor cells. PURPOSE: This randomized phase II trial is studying how well giving radiation therapy together with either gefitinib or temozolomide works in treating patients with non-small cell lung cancer and brain metastases.
Detailed Description
OBJECTIVES: Primary Compare the efficacy of whole-brain radiotherapy combined with either gefitinib or temozolomide, in terms of overall survival, in patients with non-small cell lung cancer and brain metastases. Secondary Compare the tolerability and toxicity of these regimens in these patients. Compare the time to neurological disease progression, time to extracranial disease progression, and time to overall disease progression, in patients treated with these regimens. Compare adverse events in patients treated with these regimens. Compare cognitive function and quality of life of patients treated with these regimens. OUTLINE: This is a randomized, open-label, parallel-group, multicenter study. Patients are stratified according to extracranial disease (yes vs no), number of brain metastases (1-3 vs ≥ 4), prior chemotherapy (yes vs no), WHO performance status (0-1 vs 2), and participating center. Patients are randomized to 1 of 2 treatment arms. Arm I: Patients undergo whole-brain radiotherapy (WBRT) once daily on days 1-5 and 8-12 and receive oral gefitinib once daily on days 1-28. Gefitinib treatment repeats every 28 days in the absence of disease progression or unacceptable toxicity. Arm II: Patients undergo WBRT as in arm I and receive oral temozolomide once daily on days 1-21. Temozolomide treatment repeats every 28 days in the absence of disease progression or unacceptable toxicity. Quality of life is assessed at baseline and on day 1 of courses 2, 3, and 5. After completion of study therapy, patients are followed every 3 months. PROJECTED ACCRUAL: A total of 30-86 patients (15-43 per treatment arm) will be accrued for this study within 3 years.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Lung Cancer, Metastatic Cancer
Keywords
stage IV non-small cell lung cancer, recurrent non-small cell lung cancer, tumors metastatic to brain

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
59 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Arm I
Arm Type
Active Comparator
Arm Description
Patients undergo whole-brain radiotherapy (WBRT) once daily on days 1-5 and 8-12 and receive oral gefitinib once daily on days 1-28. Gefitinib treatment repeats every 28 days in the absence of disease progression or unacceptable toxicity
Arm Title
Arm II
Arm Type
Active Comparator
Arm Description
Patients undergo WBRT as in arm I and receive oral temozolomide once daily on days 1-21. Temozolomide treatment repeats every 28 days in the absence of disease progression or unacceptable toxicity
Intervention Type
Drug
Intervention Name(s)
gefitinib
Intervention Description
Once daily during days 1-28
Intervention Type
Drug
Intervention Name(s)
temozolomide
Intervention Description
Once daily on days 1-21
Intervention Type
Radiation
Intervention Name(s)
radiation therapy
Intervention Description
Whole brain radiotherapy
Primary Outcome Measure Information:
Title
Overall survival
Time Frame
life-long
Secondary Outcome Measure Information:
Title
Time to progression
Time Frame
28 days
Title
Time to neurological progression
Time Frame
28 days
Title
Time to extracranial disease progression
Time Frame
28 days
Title
Adverse events as measured at completion of study treatment
Time Frame
28 days

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
DISEASE CHARACTERISTICS: Histologically or cytologically confirmed non-small cell lung cancer AND newly diagnosed brain metastases meeting 1 of the following criteria: Multiple brain metastases Single brain metastasis not amenable to potentially curative treatment No advanced extracranial disease severely compromising vital functions and performance PATIENT CHARACTERISTICS: Age 18 and over Performance status WHO 0-2 Life expectancy Not specified Hematopoietic Hemoglobin > 10 g/dL Absolute neutrophil count > 1,500/mm^3 Platelet count > 100,000/mm^3 Hepatic Bilirubin ≤ 1.5 times upper limit of normal (ULN) AST and ALT ≤ 2.5 times ULN Alkaline phosphatase ≤ 2.5 times ULN (5 times ULN in the presence of documented bone metastases) No unstable or uncompensated hepatic disease that would preclude study participation Renal Creatinine clearance ≥ 40 mL/min No unstable or uncompensated renal disease that would preclude study participation Cardiovascular No myocardial infarction within the past 3 months No unstable or uncompensated cardiac disease that would preclude study participation Pulmonary No clinically active interstitial lung disease Patients with chronic stable radiographic changes who are asymptomatic eligible No other unstable or uncompensated respiratory disease that would preclude study participation Other Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception during and for 12 months after completion of study treatment No nausea, vomiting, inability to swallow whole tablets/capsules, or malabsorption syndrome that would preclude oral medication ingestion or absorption No psychiatric disorder that would preclude giving informed consent or study compliance No active infection No uncontrolled diabetes mellitus No other medical condition that would preclude study participation PRIOR CONCURRENT THERAPY: Biologic therapy Not specified Chemotherapy No prior temozolomide Endocrine therapy Concurrent corticosteroids allowed provided dose has been stable or decreasing for ≥ 4 days before study entry Radiotherapy No prior brain irradiation Surgery Not specified Other No prior gefitinib or erlotinib More than 30 days since prior investigational clinical trial participation No other concurrent experimental drugs No other concurrent anticancer therapy No concurrent treatment with any of the following: Phenytoin Carbamazepine Rifampin Barbiturates Hypericum perforatum (St. John's wort) Other enzyme-inducing anti-epileptic drugs or tuberculostatic treatments Any drug that contraindicates administration with study drugs
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Gianfranco Pesce, MD
Organizational Affiliation
Istituto Oncologico della Svizzera Italiana - Ospedale San Giovanni
Official's Role
Study Chair
First Name & Middle Initial & Last Name & Degree
Roger Stupp, MD
Organizational Affiliation
Centre Hospitalier Universitaire Vaudois
Official's Role
Principal Investigator
Facility Information:
Facility Name
Oncology Institute of Southern Switzerland
City
Bellinzona
ZIP/Postal Code
CH-6500
Country
Switzerland
Facility Name
Kantonsspital Graubuenden
City
Chur
ZIP/Postal Code
CH-7000
Country
Switzerland
Facility Name
Centre Hospitalier Universitaire Vaudois
City
Lausanne
ZIP/Postal Code
CH-1011
Country
Switzerland

12. IPD Sharing Statement

Citations:
PubMed Identifier
22093943
Citation
Pesce GA, Klingbiel D, Ribi K, Zouhair A, von Moos R, Schlaeppi M, Caspar CB, Fischer N, Anchisi S, Peters S, Cathomas R, Bernhard J, Kotrubczik NM, D'Addario G, Pilop C, Weber DC, Bodis S, Pless M, Mayer M, Stupp R. Outcome, quality of life and cognitive function of patients with brain metastases from non-small cell lung cancer treated with whole brain radiotherapy combined with gefitinib or temozolomide. A randomised phase II trial of the Swiss Group for Clinical Cancer Research (SAKK 70/03). Eur J Cancer. 2012 Feb;48(3):377-84. doi: 10.1016/j.ejca.2011.10.016. Epub 2011 Nov 15.
Results Reference
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Radiation Therapy Combined With Either Gefitinib or Temozolomide in Pats With NSCLC and Brain Metastases

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