Stage IV Non-small Cell Lung Cancer Clinical Trial
Official title:
Three-Arm Randomized Phase II Study of Carboplatin and Paclitaxel in Combination With Cetuximab, IMC-A12 or Both in Patients With Advanced Non-Small Cell Lung Cancer Who Will Not Receive Bevacizumab-Based Therapy
This randomized phase II trial is studying how well giving carboplatin and paclitaxel together with cetuximab and/or cixutumumab (IMC-A12) works in treating patients with stage IIIB or stage IV non-small cell lung cancer. Drugs used in chemotherapy, such as carboplatin and paclitaxel, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Monoclonal antibodies, such as cetuximab and cixutumumab, can block tumor growth in different ways. Some block the ability of tumor cells to grow and spread. Others find tumor cells and help kill them or carry tumor-killing substances to them. Giving chemotherapy together with monoclonal antibody therapy may kill more tumor cells. It is not yet known whether carboplatin and paclitaxel are more effective when given with cetuximab and/or cixutumumab in treating non-small cell lung cancer.
PRIMARY OBJECTIVES:
I. To evaluate the progression-free survival of patients with non-small cell lung cancer
(NSCLC) randomized to carboplatin plus paclitaxel plus cetuximab or carboplatin plus
paclitaxel plus cixutumumab (IMC-A12) or carboplatin plus paclitaxel plus cetuximab plus
cixutumumab.
SECONDARY OBJECTIVES:
I. To evaluate the response rate, disease control rate (complete response plus partial
response plus stable disease), and toxicities for each arm.
II. To evaluate epidermal growth factor receptor (EGFR) by Immunohistochemistry (IHC),
mutation, and gene copy number, Insulin-like growth factor 1 receptor (IGF-1R) and
Insulin-like growth factor 2 receptor (IGF-2R) expression (both phosphorylated and
unphosphorylated states), expression of p-AKT (ie, Protein Kinase B) by IHC, and k-ras
mutation.
III. Plasma-based biomarkers will be evaluated for total and free insulin-like growth factor
1 and 2, IGF-growth factor binding protein 3 (IGFBP3) and circulating levels of epidermal
growth factor (EGF) and Transforming growth factor (TGF) alpha.
IV. To evaluate overall survival on each of the three arms.
OUTLINE: This is a multicenter study. Patients are stratified according to gender and
histology (squamous cell vs non-squamous cell). Patients are randomized to 1 of 3 treatment
arms.
ARM I: Patients receive carboplatin intravenously (IV) over 15-30 minutes and paclitaxel IV
over 3 hours on days 1 and 22 and cetuximab IV over 1-2 hours on days 1, 8, 15, 22, 29, and
36. Treatment repeats every 42 days for 2 courses. Patients with stable or responding
disease after 2 courses proceed to maintenance therapy with cetuximab alone on days 1, 8,
15, 22, 29, and 36. Treatment with cetuximab repeats every 42 days in the absence of disease
progression or unacceptable toxicity.
ARM II: Patients receive carboplatin and paclitaxel as in arm I. Patients also receive
cixutumumab IV over 1 hour on days 1, 15, and 29. Treatment repeats every 42 days for 2
courses. Patients with stable or responding disease after 2 courses proceed to maintenance
therapy with cixutumumab alone on days 1, 15, and 29. Treatment with cixutumumab repeats
every 42 days in the absence of disease progression or unacceptable toxicity.
ARM III: Patients receive carboplatin, paclitaxel, and cetuximab as in arm I. Patients also
receive cixutumumab as in arm II. Treatment repeats every 42 days for 2 courses. Patients
with stable or responding disease after 2 courses proceed to maintenance therapy with
cetuximab as in arm I and cixutumumab as in arm II.
Tumor tissue samples are collected at baseline for analysis of EGFR expression by IHC,
mutation, and gene copy number; IGF-1R and IGF-2R expression (both phosphorylated and
unphosphorylated states); p-AKT expression by IHC; and k-ras mutation. Blood, serum, and
plasma samples are collected periodically for biomarker analysis.
After completion of study treatment, patients are followed up every 3 months for 2 years and
then every 6 months for 1 year.
PROJECTED ACCRUAL: 200 patients
;
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
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