Customizing First Line Chemotherapy in Advanced Non-Small Cell Lung Cancer

Non-Small Cell Lung Cancer Clinical Trial

— Customizing  

Official title:

A Pilot Study of Customizing First Line Chemotherapy in Advanced Non-Small Cell Lung Cancer Based on Molecular Markers

Clinical Trial Details — Status: Terminated

Administrative data

• NCT number: NCT01356368
• Other study ID #: RC09/095
• Status: Terminated
• Phase: Phase 2
• First received: March 19, 2011
• Last updated: January 19, 2014
• Start date: May 2010
• Est. completion date: May 2013

Study information

• Verified date: January 2014
• Source: National Guard Health Affairs
• Contact: n/a
• Is FDA regulated: No
• Health authority: Saudi Arabia: Ethics Committee
• Study type: Interventional

Clinical Trial Summary

The study aims at piloting the concept of customization of chemotherapy based on molecular markers in patients with stage IIIB (with pleural effusion) and IV with performance status ≤ 2 with pathologically proven non-small cell lung cancer (NSCLC). The study will not test or compare individual regimen but rather it will test the approach of customization concept as a whole.

The results of this pilot study will help in designing more definitive trials in our patient population.

Description:

The treatment of advanced NSCLC cancer includes various chemotherapies with equivalent regimens that have reached a therapeutic plateau. The selection of these regimens is completely empirical and physician dependent. Potential predictors of specific agent efficacy exist in the form of tumor molecular markers that are a reflection of the individual's genetic make up. Thus our study aims at utilizing these markers to more efficiently select the regimen in order to maximize the benefit to the patients rather than using empiric approaches. Fortunately, each of our selected regimens contains active and well-studied agents in the treatment of lung cancer (Table 1). This pilot study will help us determine the benefit, and safety of this approach (not individual regimen). The study is not to compare individual regimens but it aims at testing the whole concept of customization of chemotherapy based on molecular markers to help us in the future at selecting regimens based on these markers and not empirically. The results then will be used to determine more definitive future studies.

Furthermore, circulating tumor cells in the blood represent the future distant metastases that result in disease progression to incurable stages. The circulating tumor cells have the ability to cross into vessels, travel in circulation, and exit the vessels into tissues where they have the capability to grow. Therefore, these cells may express different biological and molecular features from the stationary cells in the primary tumors. Therefore, exploiting these circulating tumor cells for augmenting treatment approaches is of vital importance and utility.

Recruitment information / eligibility

• Status: Terminated
• Enrollment: 3
• Est. completion date: May 2013
• Est. primary completion date: May 2013
• Accepts healthy volunteers: No
• Gender: Both
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

1. Microscopic diagnosis of NSCLC stages IIIB (with malignant pleural effusion) and IV

2. Having adequate tissue sample to perform the markers testing

3. Age = 18 years

4. No prior chemotherapy treatment for lung cancer (Surgery and radiotherapy are acceptable)

5. No other concurrent cancer treatment

6. Performance status of 0- 2 per ECOG scale (Appendix II)

7. Adequate laboratory values as follows as follows:

Absolute neutrophil count = 1500/mm3 Platelet count =100, 000/ mm3 Total bilirubin = 1.25X institutional upper normal level AST and ALT = 3 X institutional upper normal level Serum creatinine = 1.5 X institutional upper normal level

8. Presence of measurable disease

Exclusion Criteria:

1. Prior systemic treatment for lung cancer

2. History of hypersensitivity to drugs used

3. Diagnosis of other malignancy in the last 5 years excluding curatively treated non-melanoma skin cancer and in-situ cervical cancer

4. Medical illness that puts the patient at significant risk per investigator's discretion

5. Uncontrolled CNS disease. Patients with CNS metastatic disease treated with radiotherapy or surgery will be eligible if the CNS disease is stable 4 weeks after the treatment initiation without increase dose of steroids

6. Positive pregnancy test or refusal to use contraception during treatment. (Gynecology consultant for contraception)

Study Design

Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment

Related Conditions & MeSH terms

• Carcinoma, Non-Small-Cell Lung
• Lung Neoplasms
• Non-Small Cell Lung Cancer

Intervention

Drug:
• Cisplatin, Gemzar, Docetaxel, Alimta
Patients will be assigned to treatment according to the molecular biological results which will analyze excision repair cross-complementing (ERCC1), ribonucleotide reductase subunit M1 (RRM1) and beta-tubulin genes in primary tumor cells which are present in tissues and peripheral blood.

Locations

Country	Name	City	State
Saudi Arabia	King Abdul Aziz Medical City for National Guard Health Affairs	Riyadh

Sponsors (1)

Lead Sponsor	Collaborator
National Guard Health Affairs

Country where clinical trial is conducted

Saudi Arabia, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Efficacy and Safety	Efficacy is measured by: overall response rate (partial response and complete response) using RECIST Criteria; time to disease progression (TTP); progression free survival (PFS); overall survival (OS); To evaluate the Number of participants with Adverse Events and Serious Adverse Events.Safety will include 5 parameters to be collected for all patients who receive the study regimen which are: Adverse Events; Laboratory Assessments; Vital Signs; Physical Examinations; ECG	3 years	Yes
Secondary	Tumor marker	The molecular characteristics of circulating tumor cells harvested from peripheral blood; Correlation between the markers of circulating tumor cells and primary tumor.	3 years	No