Stage IV Lung Non-Small Cell Cancer AJCC v7 Clinical Trial
Official title:
A Randomized Phase II Trial of Erlotinib Alone or in Combination With Bevacizumab in Patients With Non-Small Cell Lung Cancer and Activating Epidermal Growth Factor Receptor Mutations
This randomized phase II trial studies how well erlotinib hydrochloride (Tarceva) with or without bevacizumab (Avastin) works in treating patients with stage IV non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) mutations. Erlotinib hydrochloride may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Monoclonal antibodies, such as bevacizumab, may block tumor growth in different ways by targeting certain cells. Bevacizumab may also stop the growth of NSCLC by blocking the growth of new blood vessels necessary for tumor growth. It is not yet known whether erlotinib hydrochloride is more effective when given alone or with bevacizumab in treating patients with NSCLC.
PRIMARY OBJECTIVE:
I. To determine the progression-free survival of erlotinib (erlotinib hydrochloride) and
bevacizumab versus that of erlotinib alone for the purpose of deciding if the combination arm
is worth pursuing in a phase III trial.
SECONDARY OBJECTIVES:
I. To investigate the overall survival of erlotinib and bevacizumab versus erlotinib alone.
II. To investigate the response rate of erlotinib and bevacizumab versus erlotinib alone.
III. To investigate the progression-free survival in patients with exon deletion 19 or exon
21 L858R point mutations.
IV. To investigate the toxicity of erlotinib and bevacizumab versus erlotinib alone using
Common Terminology Criteria for Adverse Events (CTCAE) version 4.0.
CORRELATIVE RESEARCH OBJECTIVES:
I. To correlate EGFR mutations detected in plasma deoxyribonucleic acid (DNA) with those
detected in tumor DNA.
II. To estimate the prevalence of EGFR T790M resistance mutations from pretreatment tumor
biopsies using more sensitive mutation detection methods.
III. To investigate progression free survival of EGFR mutant NSCLC patients with and without
concurrent EGFR T790M detected from pre-treatment tumor specimen using allele specific
quantitative polymerase chain reaction (PCR).
IV. To prospectively evaluate the predictive value of plasma VEGF-A levels on progression
free survival in patients treated with erlotinib alone or in combination with bevacizumab.
OUTLINE: Patients are randomized to 1 of 2 treatment arms.
ARM A: Patients receive erlotinib hydrochloride orally (PO) once daily (QD) on days 1-21.
(erlotinib will no longer be supplied and all patients will be removed from study treatment.
No further follow-up by any study participants as of September 1, 2019)
ARM B: Patients receive erlotinib hydrochloride as in Arm A and bevacizumab intravenously
(IV) over 30-90 minutes on day 1. (erlotinib will no longer be supplied and all patients will
be removed from study treatment. No further follow-up by any study participants as of
September 1, 2019)
In both arms, courses repeat every 21 days in the absence of disease progression or
unacceptable toxicity.
After completion of study treatment, patients are followed up every 3-6 months for 6 years.
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