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

Lung Cancer Clinical Trial

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

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT00238251
• Other study ID #: SAKK 70/03
• Secondary ID: EU-20526
• Status: Completed
• Phase: Phase 2
• First received: October 12, 2005
• Last updated: June 4, 2012
• Start date: May 2005
• Est. completion date: November 2010

Study information

• Verified date: June 2012
• Source: Swiss Group for Clinical Cancer Research
• Contact: n/a
• Is FDA regulated: No
• Health authority: Switzerland: Swissmedic
• Study type: Interventional

Clinical Trial 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.

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.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 59
• Est. completion date: November 2010
• Est. primary completion date: April 2009
• Accepts healthy volunteers: No
• Gender: Both
• Age group: 18 Years and older

Eligibility

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

Study Design

Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment

Related Conditions & MeSH terms

• Lung Cancer
• Lung Neoplasms
• Metastatic Cancer
• Neoplasm Metastasis

Intervention

Drug:
• gefitinib
Once daily during days 1-28
• temozolomide
Once daily on days 1-21

Radiation:
• radiation therapy
Whole brain radiotherapy

Locations

Country	Name	City	State
Switzerland	Oncology Institute of Southern Switzerland	Bellinzona
Switzerland	Kantonsspital Graubuenden	Chur
Switzerland	Centre Hospitalier Universitaire Vaudois	Lausanne

Sponsors (1)

Lead Sponsor	Collaborator
Swiss Group for Clinical Cancer Research

Country where clinical trial is conducted

Switzerland, 

References & Publications (1)

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 — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Overall survival		life-long	No
Secondary	Time to progression		28 days	No
Secondary	Time to neurological progression		28 days	No
Secondary	Time to extracranial disease progression		28 days	No
Secondary	Adverse events as measured at completion of study treatment		28 days	Yes