R-(-)-Gossypol Acetic Acid in Treating Patients With Recurrent Extensive-Stage Small Cell Lung Cancer

A Phase II Study of AT-101 in Recurrent Extensive Stage Small Cell Lung Cancer

This phase II trial is studying how well R-(-)-gossypol acetic acid works in treating patients with recurrent extensive-stage small cell lung cancer. Drugs used in chemotherapy, such as R-(-)-gossypol acetic acid, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing.

Study Overview

• Status: Completed
• Conditions: Extensive Stage Small Cell Lung Cancer; Recurrent Small Cell Lung Cancer
• Intervention / Treatment: Other: laboratory biomarker analysis; Other: pharmacological study; Drug: R-(-)-gossypol acetic acid

Detailed Description

PRIMARY OBJECTIVES:

I. To determine the objective response rate of R-(-)-gossypol in patients with recurrent chemotherapy-sensitive extensive stage small cell lung cancer.

II. To determine the time to disease progression. III. To determine the overall survival. IV. To assess the toxicities associated with this drug. V. To explore whether intratumoral Bcl-2 family member expression correlates with sensitivity to targeting by R-(-)-gossypol.

VI. To explore whether the administration of R-(-)-gossypol causes specific induction of the intrinsic apoptotic pathway.

OUTLINE: This is a multicenter study.

Patients receive oral R-(-)-gossypol once daily on days 1-21. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.

Blood is collected periodically during treatment for pharmacodynamic analysis. Peripheral blood mononuclear cells are analyzed via protein isolation and western blotting for Bcl-2, cytoplasmic release of cytochrome c, and caspase activation. Available tumor tissue blocks are assessed by immunohistochemistry.

After completion of study therapy, patients are followed periodically for up to 5 years.

• Study Type: Interventional
• Enrollment (Actual): 15
• Phase: Phase 2

Contacts and Locations

Study Locations

• United States
  • Minnesota
    • Rochester, Minnesota, United States, 55905
      • Mayo Clinic

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Histologically or cytologically confirmed small cell lung cancer

  • Extensive stage disease
  • Recurrent disease
• Measurable disease

• Chemotherapy-sensitive disease, defined as:

  • No progression during first-line chemotherapy
  • No disease recurrence < 2 months after completion of first-line chemotherapy
• Must have received prior platinum-based chemotherapy

• No symptomatic or progressive brain metastases

  • Patients with previously treated brain metastases who are clinically and radiographically stable or improved and have been off steroids ≥ 14 days are eligible
• ECOG performance status 0-2
• Life expectancy > 12 weeks
• Leukocytes ≥ 3,000/μL
• ANC ≥ 1,500/μL
• Platelet count ≥ 100,000/μL
• Total bilirubin < 1.5 mg/dL
• AST and ALT ≤ 2.5 times upper limit of normal
• Serum creatinine ≤ 1.5 mg/dL OR creatinine clearance ≥ 60 mL/min
• Hemoglobin > 8 g/dL
• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception before, during, and for 30 days after completion of study therapy
• Able to take oral medications on a regular basis
• Willing to provide blood samples for mandatory correlative studies

• No condition that impairs the ability to swallow and retain R-(-)-gossypol tablets, including the following:

  • Gastrointestinal tract disease resulting in an inability to take oral medication or a requirement for IV alimentation
  • Active peptic ulcer disease
• No malabsorption syndrome or disease significantly affecting gastrointestinal function
• No ulcerative colitis, inflammatory bowel disease, or a partial or complete small bowel obstruction

• No uncontrolled concurrent illness including, but not limited to, any of the following:

  • Ongoing or active infection
  • Symptomatic congestive heart failure
  • Unstable angina pectoris
  • Cardiac arrhythmia
  • Psychiatric illness or social situations that would limit compliance with study requirements
• No symptomatic hypercalcemia > grade 2
• No requirement for routine use of hematopoietic growth factors (including G-CSF, GM-CSF, or IL-11) or platelet transfusions to maintain ANC or platelet counts
• No history of allergic reactions attributed to compounds of similar chemical or biologic composition to R-(-)-gossypol
• No HIV positivity
• Recovered from all prior therapy, including prior surgical procedures
• No prior surgical procedures affecting absorption
• No prior resection of the stomach or small bowel
• No more than one prior chemotherapy regimen
• No prior racemic gossypol or R-(-)-gossypol
• At least 4 weeks since prior chemotherapy (6 weeks for nitrosoureas or mitomycin C)
• At least 4 weeks since prior radiotherapy, hormonal agents, or biologic response modifiers
• At least 4 weeks since prior and no concurrent investigational agents or devices
• No concurrent prophylactic hematopoietic growth factors (including filgrastim [G-CSF], sargramostim [GM-CSF], or interleukin-11 [IL-11]) during course one
• No concurrent combination antiretroviral therapy for HIV-positive patients

Study Plan

How is the study designed?

Design Details

• Primary Purpose: TREATMENT
• Allocation: NA
• Interventional Model: SINGLE_GROUP
• Masking: NONE

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
EXPERIMENTAL: Treatment (R-(-)-gossypol); Patients receive oral R-(-)-gossypol once daily on days 1-21. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.	Other: laboratory biomarker analysis; Correlative studies; Other: pharmacological study; Correlative studies; Other Names: pharmacological studies; Drug: R-(-)-gossypol acetic acid; Given orally; Other Names: AT-101

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of Participants With Confirmed Tumor Response Defined to be Either a Complete Response (CR) or Partial Response (PR)	The number of successes will be estimated by counting the number of participants with confirmed responses. A confirmed tumor response is defined to be either a CR or PR noted as the objective status on 2 consecutive evaluations at least 4 weeks apart. Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0) for target lesions: A Complete Response (CR) requires the disappearance of all target lesions A Partial Response (PR) requires a >=30% decrease in the sum of the longest diameter of target lesions from baseline measurements.	During the first 6 courses of treatment

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Survival Time	Estimated using the method of Kaplan-Meier.	From registration to death due to any cause, assessed up to 5 years
Time to Disease Progression	Time to disease progression is defined as the time from registration to the earliest date documentation of disease progression. Estimated using the method of Kaplan-Meier. Per the RECIST criteria, progression is defined as at least a 20% increase in the sum of Longest Dimension (LD) of target lesions taking as reference the smallest sum LD recorded since the treatment started or the appearance of one or more new lesions.	From registration to the earliest date documentation of disease progression, assessed up to 5 years
Duration of Response		From the date at which the patient's earliest best objective status is first noted to be either a CR or PR to the earliest date progression is documented, assessed up to 5 years

Collaborators and Investigators

• Sponsor: National Cancer Institute (NCI)
• Investigators: Principal Investigator: Maria Baggstrom, Mayo Clinic

Study record dates

Study Major Dates

• Study Start: November 1, 2008
• Primary Completion (ACTUAL): October 1, 2009
• Study Completion (ACTUAL): August 1, 2010

Study Registration Dates

• First Submitted: October 15, 2008
• First Submitted That Met QC Criteria: October 15, 2008
• First Posted (ESTIMATE): October 16, 2008

Study Record Updates

• Last Update Posted (ESTIMATE): May 12, 2014
• Last Update Submitted That Met QC Criteria: April 23, 2014
• Last Verified: October 1, 2011

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Respiratory Tract Diseases; Neoplasms; Lung Diseases; Neoplasms by Site; Disease Attributes; Respiratory Tract Neoplasms; Thoracic Neoplasms; Carcinoma, Bronchogenic; Bronchial Neoplasms; Lung Neoplasms; Recurrence; Small Cell Lung Carcinoma; Physiological Effects of Drugs; Anti-Infective Agents; Antineoplastic Agents; Immunologic Factors; Protective Agents; Antineoplastic Agents, Phytogenic; Anti-Bacterial Agents; Adjuvants, Immunologic; Contraceptive Agents; Reproductive Control Agents; Contraceptive Agents, Female; Anticarcinogenic Agents; Contraceptive Agents, Male; Spermatocidal Agents; Antispermatogenic Agents; Acetic Acid; Gossypol; Retinol acetate; Gossypol acetic acid
• Other Study ID Numbers: NCI-2009-01058 (REGISTRY: CTRP (Clinical Trial Reporting Program)); P30CA015083 (U.S. NIH Grant/Contract); N01CM62205 (U.S. NIH Grant/Contract); N01CM62209 (U.S. NIH Grant/Contract); MAYO-MC0721; CDR0000616965; MC0721 (OTHER: Mayo Clinic); 8027 (Other Identifier: Fred Hutch/University of Washington Cancer Consortium)