- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT00104728
Neoadjuvant IRESSA As Single Agent PreopTherapy for NSCLC With Molecular Correlates
Pilot Neoadjuvant Study of ZD1839 (IRESSA®) as Single Agent Preoperative Therapy for Clinical Stage 1A and 1B (T1-2N0), II (T1-2N1, T3N0) and Selected IIIA (T3N1) Non-Small Cell Lung Cancer (NSCLC) With Molecular Correlates
RATIONALE: Gefitinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Giving gefitinib before surgery may shrink the tumor so it can be removed.
PURPOSE: This phase II trial is studying how well gefitinib works in treating patients who are undergoing surgery for stage I, stage II, or stage III non-small cell lung cancer.
Study Overview
Detailed Description
OBJECTIVES:
Primary
- Determine the effects of neoadjuvant gefitinib on downstream signaling pathways, including Src-Stat3, PI3K/Akt, ERK activity, and Bcl-2 family members in patients with resectable stage I-IIIA non-small cell lung cancer.
- Determine the effects of this drug on cell cycle and apoptosis within the primary tumor, by measuring changes in pre- and post-treatment Ki-67, Mcm2, cleaved caspase-3, and ApoTag, in these patients.
Secondary
- Determine the clinical response rate in patients treated with this drug.
- Determine the pathological response rate, defined as > 95% necrosis or fibrosis in the pathological specimen, in patients treated with this drug.
- Determine the metabolic activity of this drug in these patients.
- Determine the safety, tolerability, and feasibility of this drug, in terms of toxicity and post-treatment resectability, in these patients.
- Correlate plasma and tumor concentrations of this drug with changes in post-treatment molecular markers in these patients.
- Identify a gene profile that predicts response to this drug in these patients.
OUTLINE: This is an open-label, pilot study.
Patients receive oral gefitinib once daily for 4 weeks in the absence of disease progression or unacceptable toxicity.
Within 3 days after completion of gefitinib, patients undergo restaging evaluation. Patients whose disease is still considered resectable proceed to surgery. Patients undergo thoracotomy with lobectomy or pneumonectomy OR sleeve resection. Patients also undergo mediastinal lymph node dissection. After surgical resection, treatment with gefitinib may continue off study at the discretion of the principal investigator.
After completion of study therapy, patients are followed at 30 days, every 4 months for 1 year, every 6 months for 1 year, and then annually thereafter.
PROJECTED ACCRUAL: A total of 50 patients will be accrued for this study within 12.5 months.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
Florida
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Tampa, Florida, United States, 33612-9497
- H. Lee Moffitt Cancer Center and Research Institute
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
DISEASE CHARACTERISTICS:
Histologically confirmed resectable non-small cell lung cancer (NSCLC), meeting 1 of the following clinical staging criteria:
- Stage IA or IB (T1-2, N0)
- Stage II (T1-2, N1 with negative mediastinoscopy or T3, N0)
Stage IIIA (T3, N1 with negative mediastinoscopy)
- Level 10 hilar nodes may be positive provided mediastinoscopy is negative
The following are not allowed (as evidenced by clinical staging criteria [CT scan, positron-emission tomography (PET) scan, or mediastinoscopy):
- Positive N2 lymph nodes (ipsilateral/subcarinal mediastinal lymph nodes)
- Positive N3 lymph nodes (contralateral mediastinal/hilar and supraclavicular/scalene lymph nodes)
- T4 primary tumor (malignant pleural effusion or mediastinal invasion)
- Symptomatic tumors (T3, N0-1) involving the superior sulcus (i.e., Pancoast tumors)
- Measurable disease by contrast-enhanced CT scan
- No metastatic disease (except peribronchial or hilar lymph node involvement [N1]) by fludeoxyglucose F 18 PET scan
No malignant pleural effusion by preoperative evaluation
- Pleural effusions visible only on CT scan that are not large enough for safe thoracentesis are allowed
No exudative effusions (even if cytologically negative), as evidenced by any of the following:
- Ratio of pleural fluid protein to serum protein > 0.5
- Ratio of pleural fluid lactic dehydrogenase (LDH) to serum LDH ≥ 0.6
- Pleural fluid LDH > 200 IU/L
- No superior vena cava syndrome
- No spinal cord compression
PATIENT CHARACTERISTICS:
Age
- 18 and over
Performance status
- Eastern Cooperative Oncology Group (ECOG) 0-1
Life expectancy
- Not specified
Hematopoietic
- WBC ≥ 4,000/mm^3
- Absolute granulocyte count ≥ 1,500/mm^3
- Platelet count ≥ 100,000/mm^3
Hepatic
- Bilirubin ≤ 1.5 times upper limit of normal (ULN)
- AST or ALT ≤ 2 times ULN
- Alkaline phosphatase ≤ 2 times ULN
Renal
- Creatinine < 1.5 times ULN
Cardiovascular
- No uncontrolled ventricular arrhythmia
- No myocardial infarction within the past 3 months
Pulmonary
- Pre-resection FEV_1 > 2.0 L OR
- Predicted post-resection FEV_1 > 1.0 L
No clinically active interstitial lung disease
- Chronic stable asymptomatic radiographic changes allowed
- No post-obstructive pneumonia
Other
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception
- Willing to provide tumor biopsy pre- and post-gefitinib administration AND undergo PET scan
- No known severe hypersensitivity to study drug or any of its excipients
- No uncontrolled major seizure disorder
- No unstable or uncontrolled diabetes mellitus
- No serious infection requiring IV antibiotics
- No grade 3 neuropathy
- No other malignancy within the past 5 years except adequately treated basal cell or squamous cell skin cancer or carcinoma in situ of the cervix
- No other unstable or serious medical condition that would preclude study treatment or surgery
- No psychiatric disorder that would preclude giving informed consent
- No psychological, familial, sociological, or geographical condition that would preclude study compliance and follow up
- No other significant clinical disorder or laboratory finding that would preclude study participation
PRIOR CONCURRENT THERAPY:
Biologic therapy
- Not specified
Chemotherapy
- No prior or concurrent systemic chemotherapy for NSCLC
Endocrine therapy
- Not specified
Radiotherapy
- No prior or concurrent radiotherapy for NSCLC
Surgery
- Recovered from prior oncologic or other major surgery
- At least 5 years since prior resection of lung disease
- No prior surgery for NSCLC
- No concurrent ophthalmic surgery
Other
- More than 30 days since prior non-approved or investigational drugs
- No other concurrent therapy for NSCLC
- No other concurrent investigational therapy
No concurrent use of any of the following medications:
- Phenytoin
- Carbamazepine
- Barbiturates (e.g., phenobarbital)
- Rifampin
- Hypericum perforatum (St. John's wort)
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Neoadjuvant ZD1839 Preoperative Therapy
The ZD1839 250-mg tablet will be taken once a day, every day about the same time. It can be taken with or without food. At the time of surgery, investigators will collect tissue from the participant's tumor once it has been removed. This tissue will be used to study the effect of ZD1839 on tumor growth. |
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Overall Response Rate (ORR)
Time Frame: 3 years
|
Objective Response Rate according to Response Evaluation Criteria In Solid Tumors (RECIST) criteria.
Investigators planned to use this pilot study of neoadjuvant ZD1839 in patients with resectable NSCLC to specifically correlate molecular parameters to the primary clinical study endpoint clinical response assessed by CT response and PET scan response of the primary tumor.
|
3 years
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Frequency of Toxicity Related to Study Treatment
Time Frame: 3 years
|
Review of adverse events utilizing Common Toxicity Criteria (CTC) V3.
To estimate the safety, tolerability, and feasibility of preoperative ZD1839 in patients with resectable Stage IA/IB, II and selected IIIA NSCLC by evaluating toxicity and operability after preoperative ZD1839.
|
3 years
|
Collaborators and Investigators
Investigators
- Principal Investigator: Eric B. Haura, M.D., H. Lee Moffitt Cancer Center and Research Institute
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- MCC-13922
- IRUSIRES0256 (Other Identifier: AstraZeneca)
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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