Advanced Nsclc Clinical Trial
Official title:
Study of Thalidomide With First-line Chemotherapy and as Maintenance Treatment of Advanced Nonsquamous NSCLC With Epidermal Growth Factor Receptor Wild-Type or Unknown Mutation Status: A Multicenter, Randomized, Prospective Clinical Trial
The study for innovative strategies is warranted in the treatment of advanced non-squamous NSCLC with epidermal growth factor receptor wild-type or unknown mutation status because the outcomes remain unsatisfactory for most patients. Maintenance treatment after first-line chemotherapy is a very interesting strategy that has been largely investigated in the last years. This study is to evaluate the efficacy and toxicity of thalidomide in combination with chemotherapy and as maintenance treatment in patients with advanced non-squamous NSCLC.
Lung cancer is the most common cancer and is the leading cause of cancer mortality in the
world. Every year, more than one million people die from lung cancer in worldwide. NSCLC
accounts for about 85% of all lung cancers diagnosis and continues to remain a major
therapeutic challenge.
Chemotherapeutic agents in the treatment of advanced NSCLC have reached a plateau of
effectiveness when administered in the classic modality. In the first-line treatment of
advanced non-squamous NSCLC with epidermal growth factor receptor wild-type, cisplatin plus
pemetrexed is considered the best chemotherapeutic regimen. Recently, the PARAMOUNT trial has
demonstrated that continuation maintenance with pemetrexed improves progression-free survival
and overall survival after induction therapy with cisplatin plus pemetrexed in advanced
non-squamous NSCLC with epidermal growth factor receptor wild-type.
Bevacizumab, a pure humanized anti-VEGF monoclonal antibody (mAb) has improved the outcomes
of chemotherapy alone when combined with chemotherapy as first-line therapy for advanced
non-squamous NSCLC. A randomized phase Ⅲ trial named Eastern Cooperative Oncology Group E4559
has demonstrated that concurrent bevacizumab with chemotherapy followed by maintenance
bevacizumab in previously untreated patients with advanced non-squamous NSCLC is associated
with an increase in overall survival.
In China, the cost of continuation maintenance with pemetrexed or bevacizumab is high in the
current economic environment.
Thalidomide is much cheaper than pemetrexed and bevacizumab, and has been shown to have
activity in numerous malignancies. Although the exact anti-tumor mechanism is unknown,
thalidomide exhibits both immuno-modulating and anti-angiogenic effects. Based on potentially
synergistic mechanisms of action, thalidomide has the potential to enhance the activity of
conventional chemotherapy. Results from previously published small studies in which
thalidomide was given concurrently with conventional chemotherapy and was continued as
maintenance therapy suggest that thalidomide might be effective in the treatment of patients
with small cell lung cancer and NSCLC. Study and evaluation the efficacy and toxicity of
thalidomide in combination with chemotherapy and as maintenance treatment in patients with
advanced non-squamous NSCLC with epidermal growth factor receptor wild-type is necessary.
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