Study of Vorinostat and Gefitinib in Relapsed/ or Refractory Patients With Advanced Non-small Cell Carcinoma (NSCLC)
Primary Purpose
Non-Small-Cell Lung Carcinoma
Status
Unknown status
Phase
Phase 1
Locations
Korea, Republic of
Study Type
Interventional
Intervention
Study treatment
Sponsored by

About this trial
This is an interventional treatment trial for Non-Small-Cell Lung Carcinoma focused on measuring Gefitinib, Vorinostat
Eligibility Criteria
Inclusion Criteria:
- Histologic or cytologic diagnosis of NSCLC, Stage IV or selected stage IIIB (with positive pleural effusion or multiple ipsilateral lung nodules) according to the American Joint Committee on Cancer (AJCC).
- Previously treated with at least one platinum-based chemotherapy.
- Before study entry, a minimum of 28 days must have elapsed since any prior chemotherapy.
- Prior radiation therapy is allowed as long as the irradiated area is not the only source of measurable disease.
- No other forms of cancer therapy, such as radiation, immunotherapy for at least 2 weeks before the enrollment in study.
- Performance status of 0-2 on the ECOG criteria.
- At least one unidimensionally measurable lesion meeting Response Evaluation Criteria in Solid Tumors (Revised RECIST guideline version 1.1)
- Estimated life expectancy of at least 8 weeks.
- Patient compliance that allow adequate follow-up.
- Adequate hematologic (WBC count 4,000/mm3, platelet count 150,000/mm3), hepatic (bilirubin level 1.5 mg/dL, AST/ALT 80 IU/L), and renal (creatinine concentration 1.5 mg/dL) function.
- Informed consent from patient or patient's relative.
- Males or females at least 18 years of age.
- If female: childbearing potential either terminated by surgery, radiation, or menopause, or attenuated by use of an approved contraceptive method (intrauterine device [IUD], birth control pills, or barrier device) during and for 3 months after trial. If male, use of an approved contraceptive method during the study and 3 months afterwards. Females with childbearing potential must have a urine negative hCG test within 7 days prior to the study enrollment.
- Patients with brain metastasis are allowed unless there were clinically significant neurological symptoms or signs
Exclusion Criteria:
- Presence of small-cell lung cancer alone or with NSCLC
- Unresolved chronic toxic effects from previous anticancer therapy: but patient could be enrolled, if they have recovered from any treatment-related toxicities NCI CTCAE grade ≤2
- Inability to swallow tablets
- Second primary malignancy (except in situ carcinoma of the cervix or adequately treated basal cell carcinoma of the skin or prior malignancy treated more than 5 years ago without recurrence).
- More than three previous chemotherapy regimens for NSCLC
- Previous treatment with any EGFR-TKI
- Patients who have been exposed to any prior HDAC inhibitor, with the exception of exception of valpronic acid used for treating seizures, provided there is a 30-day washout period
- Patients with active HIV or hepatitis B or C infection
- Concomitant use of phenytoin, carbamazepine, rifampicin, barbiturates, cyclosporine A, valpronic acid, Phenobarbital, ketoconazole, coumarin-derivative anticoagulants or St John's wort; severe or uncontrolled systemic disease; clinically active interstitial lung disease (except uncomplicated lymphangitic carcinomatosis) pregnancy; and breastfeeding.
- MI within preceding 6 months or symptomatic heart disease, including unstable angina, congestive heart failure or uncontrolled arrhythmia
- Serious concomitant infection including postobstructive pneumonia
- Major surgery other than biopsy within the past two weeks.
Sites / Locations
- National Cancer Center
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
study arm
Arm Description
single arm Gefitinib plus vorinostat
Outcomes
Primary Outcome Measures
Progression-Free Survival
The first day of treatment to the date that disease progression is reported or death date
Secondary Outcome Measures
Overall Survival
The first day of treatment to the date that death is reported or last survival status reported or
Objective Response rate
The date of first evaluation to the date of disease progression
Full Information
NCT ID
NCT01027676
First Posted
December 8, 2009
Last Updated
November 13, 2013
Sponsor
National Cancer Center, Korea
Collaborators
Merck Sharp & Dohme LLC
1. Study Identification
Unique Protocol Identification Number
NCT01027676
Brief Title
Study of Vorinostat and Gefitinib in Relapsed/ or Refractory Patients With Advanced Non-small Cell Carcinoma (NSCLC)
Official Title
Phase I/II Study of Vorinostat and Gefitinib in Relapsed/ or Refractory Patients With Advanced Non-small Cell Carcinoma (NSCLC)
Study Type
Interventional
2. Study Status
Record Verification Date
November 2013
Overall Recruitment Status
Unknown status
Study Start Date
June 2010 (undefined)
Primary Completion Date
December 2013 (Anticipated)
Study Completion Date
March 2014 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
National Cancer Center, Korea
Collaborators
Merck Sharp & Dohme LLC
4. Oversight
Data Monitoring Committee
No
5. Study Description
Brief Summary
Gefitinib is an orally active epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) and produces 8-20% of response rates in patients with advanced non-small cell lung cancer (NSCLC). Vorinostat (suberoylanilide hydroxamic acid [SAHA]) is a small-molecule inhibitor of histone deacetylase (HDAC) and induces cell differentiation, cell cycle arrest, and apoptosis in several tumor cells. There is a strong synergistic antiproliferative effect of vorinostat in combination with gefitinib in NSCLC cells. Vorinostat increases expression of E-cadherin and ErbB-3, which results in increased sensitivity to gefitinib. Moreover, In-vitro studies have shown that vorinostat leads to acetylation and disruption of Hsp90, which may lead to decreases in activity of pro-growth and prosurvival client proteins (J Bio Chem 2005;280:26729, Br J Cancer 2006;95:S2). These findings suggest that combination of vorinostat with gefitinib may improve the efficacy of gefitinib in NSCLC.
Detailed Description
Phase I design
Three patients will be treated per cohort for one cycle (28 days per cycle).
If no DLTs are recorded, treatment will continue and three patients will be treated in the subsequent cohort.
However, if a patient develops a DLT, another three patients will be treated in this cohort for one cycle.
If there are no more DLTs, dose escalation continues.
If more than one of three patients develop a DLT in any cohort, another three patients will be treated in the next lower dosage cohort.
If no DLTs are recorded in any of the cohorts, cohort 3 will be expanded to six patients.
Up to 12 patients will be enrolled at the MTD.
The phase II dose for this combined treatment will be therefore defined as the highest dosage cohort in which six patients had been treated and there are less than three DLTs.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Non-Small-Cell Lung Carcinoma
Keywords
Gefitinib, Vorinostat
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
50 (Anticipated)
8. Arms, Groups, and Interventions
Arm Title
study arm
Arm Type
Experimental
Arm Description
single arm Gefitinib plus vorinostat
Intervention Type
Drug
Intervention Name(s)
Study treatment
Intervention Description
Gefitinib 250mg/QD plus vorinostat D1~7 & D15-21 / QD q 4weeks
Primary Outcome Measure Information:
Title
Progression-Free Survival
Description
The first day of treatment to the date that disease progression is reported or death date
Time Frame
every 8 weeks
Secondary Outcome Measure Information:
Title
Overall Survival
Description
The first day of treatment to the date that death is reported or last survival status reported or
Time Frame
every 8 weeks
Title
Objective Response rate
Description
The date of first evaluation to the date of disease progression
Time Frame
every 8 weeks
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Histologic or cytologic diagnosis of NSCLC, Stage IV or selected stage IIIB (with positive pleural effusion or multiple ipsilateral lung nodules) according to the American Joint Committee on Cancer (AJCC).
Previously treated with at least one platinum-based chemotherapy.
Before study entry, a minimum of 28 days must have elapsed since any prior chemotherapy.
Prior radiation therapy is allowed as long as the irradiated area is not the only source of measurable disease.
No other forms of cancer therapy, such as radiation, immunotherapy for at least 2 weeks before the enrollment in study.
Performance status of 0-2 on the ECOG criteria.
At least one unidimensionally measurable lesion meeting Response Evaluation Criteria in Solid Tumors (Revised RECIST guideline version 1.1)
Estimated life expectancy of at least 8 weeks.
Patient compliance that allow adequate follow-up.
Adequate hematologic (WBC count 4,000/mm3, platelet count 150,000/mm3), hepatic (bilirubin level 1.5 mg/dL, AST/ALT 80 IU/L), and renal (creatinine concentration 1.5 mg/dL) function.
Informed consent from patient or patient's relative.
Males or females at least 18 years of age.
If female: childbearing potential either terminated by surgery, radiation, or menopause, or attenuated by use of an approved contraceptive method (intrauterine device [IUD], birth control pills, or barrier device) during and for 3 months after trial. If male, use of an approved contraceptive method during the study and 3 months afterwards. Females with childbearing potential must have a urine negative hCG test within 7 days prior to the study enrollment.
Patients with brain metastasis are allowed unless there were clinically significant neurological symptoms or signs
Exclusion Criteria:
Presence of small-cell lung cancer alone or with NSCLC
Unresolved chronic toxic effects from previous anticancer therapy: but patient could be enrolled, if they have recovered from any treatment-related toxicities NCI CTCAE grade ≤2
Inability to swallow tablets
Second primary malignancy (except in situ carcinoma of the cervix or adequately treated basal cell carcinoma of the skin or prior malignancy treated more than 5 years ago without recurrence).
More than three previous chemotherapy regimens for NSCLC
Previous treatment with any EGFR-TKI
Patients who have been exposed to any prior HDAC inhibitor, with the exception of exception of valpronic acid used for treating seizures, provided there is a 30-day washout period
Patients with active HIV or hepatitis B or C infection
Concomitant use of phenytoin, carbamazepine, rifampicin, barbiturates, cyclosporine A, valpronic acid, Phenobarbital, ketoconazole, coumarin-derivative anticoagulants or St John's wort; severe or uncontrolled systemic disease; clinically active interstitial lung disease (except uncomplicated lymphangitic carcinomatosis) pregnancy; and breastfeeding.
MI within preceding 6 months or symptomatic heart disease, including unstable angina, congestive heart failure or uncontrolled arrhythmia
Serious concomitant infection including postobstructive pneumonia
Major surgery other than biopsy within the past two weeks.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
JI-YOUN HAN, M.D.
Organizational Affiliation
National Cancer Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
National Cancer Center
City
Goyang-si
State/Province
Gyeonggi-do
ZIP/Postal Code
410-769
Country
Korea, Republic of
12. IPD Sharing Statement
Citations:
PubMed Identifier
25552401
Citation
Han JY, Lee SH, Lee GK, Yun T, Lee YJ, Hwang KH, Kim JY, Kim HT. Phase I/II study of gefitinib (Iressa((R))) and vorinostat (IVORI) in previously treated patients with advanced non-small cell lung cancer. Cancer Chemother Pharmacol. 2015 Mar;75(3):475-83. doi: 10.1007/s00280-014-2664-9. Epub 2015 Jan 1.
Results Reference
derived
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Study of Vorinostat and Gefitinib in Relapsed/ or Refractory Patients With Advanced Non-small Cell Carcinoma (NSCLC)
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