Neoadjuvant Platinum-based Chemotherapy for Patients With Resectable , Non-small Cell Lung Cancer With Switch to Chemotherapy Alternative in Nonresponders (NEOSCAN)

Phase II Trial of Neoadjuvant Platinum-based Chemotherapy for Patients With Resectable , Non-small Cell Lung Cancer With Switch to Chemotherapy Alternative in Nonresponders (NEOSCAN)

The purpose of this study is to test a new approach to the use of standard drugs before surgery in patients with lung cancer. This study will find out what effects, good and/or bad, that this approach has on the cancer.

It is routine to give chemotherapy prior to surgery in patients with this type of lung cancer, to help keep it from coming back. It is also routine to perform a special type of scan called a PET scan. This PET scan measures how active a cancer is by use of a special tracer made out of sugar. In this study, all patients will have a PET scan and then be treated with standard chemotherapy drugs, either pemetrexed and cisplatin if the cancer is a "non-squamous" cancer or gemcitabine and cisplatin if the cancer is a squamous cancer. In rare cases, the doctor will decide to give carboplatin instead of cisplatin. In most patients, a repeat PET scan will show that the tumor is decreasing and they will complete standard chemotherapy then go on to have surgery.

In some patients, a repeat PET scan will show that the tumor has not decreased enough. For these patients, the routine practice is to proceed with surgery. This research study will test whether switching from the standard treatment of pemetrexed and cisplatin or gemcitabine and cisplatin to a different treatment called vinorelbine and docetaxel is safe and effective. Vinorelbine and docetaxel are also standard chemotherapy drugs which work in a different way than pemetrexed or gemcitabine and cisplatin.

Study Overview

• Status: Completed
• Conditions: Lung Cancer
• Intervention / Treatment: Drug: Docetaxel; Drug: cisplatin; Drug: Carboplatin; Drug: Gemcitabine Hydrochloride; Drug: pemetrexed; Drug: Vinorelbine Tartrate

• Study Type: Interventional
• Enrollment (Actual): 42
• Phase: Phase 2

Contacts and Locations

Study Locations

• United States
  • New Jersey
    • Basking Ridge, New Jersey, United States
      • Memoral Sloan Kettering Cancer Center
  • New York
    • Commack, New York, United States, 11725
      • Memorial Sloan-Kettering Cancer Center @ Suffolk
    • New York, New York, United States, 10065
      • Memorial Sloan Kettering Cancer Center
    • Rockville Centre, New York, United States
      • Memorial Sloan-Kettering at Mercy Medical Center
    • Sleepy Hollow, New York, United States, 10591
      • Memorial Sloan-Kettering Cancer Center at Phelps Memorial Hospital Center

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:

• Pathologic confirmation of NSCLC at MSKCC
• Stages IB, IIA, IIB, IIIA or IIIB NSCLC
• Primary tumor must measure ≥ 2 cm on CT imaging (per PERCIST guidelines)
• Primary tumor must be FDG-avid with an SUVmax >4.5 (to be consistent with PERCIST guidelines)
• Patients must be candidates for resection with curative intent
• Age ≥ 18 years
• Karnofsky performance status ≥ 70%
• Normal bone marrow function
• leukocytes ≥ 3,000/μl
• absolute neutrophil count ≥ 1,500/μl
• platelets ≥100,000/μl
• hemoglobin ≥9gm/dl.
• Adequate hepatic function
• Total bilirubin ≤1.5 x ULN
• AST ≤ 1.5 x UNL, ALT ≤ 1.5 x ULN
• Alkaline phosphatase ≤ 1.5x ULN
• Women of childbearing age must have a negative pregnancy test
• Men and women of childbearing potential must be willing to use effective contraception while on treatment and for at least 3 months thereafter
• Patients must have the ability to understand and the willingness to sign a written informed consent document

Exclusion Criteria:

• Patients must not be receiving any other investigational agents
• History of myocardial infarction or unstable angina within the past 12 months Patients with peripheral neuropathy > grade 1
• Other serious illness or medical condition including unstable cardiac disease requiring treatment, history of significant neurologic or psychiatric disorders (including psychotic disorders, dementia, or seizures), or active uncontrolled infection.
• Patients with diabetes mellitus requiring insulin therapy (per PERCIST guidelines)
• Patients with third space fluid which cannot be adequately controlled with drainage
• Women who are pregnant or breast-feeding
• Psychiatric illness or social situation that would limit compliance with study requirements
• Patients with known HIV infection requiring antiretroviral medications and those with AIDS
• Baseline subjective hearing deficit, even if it does not require a hearing aid or intervention, or interfere with activities of daily living (CTCAE grade 2 or higher)
• Baseline renal function <60 ml/min as calculated by the equation of Cockcroft and Gault using the patient's age, weight (kg), and serum creatinine (mg/dl).
• Congestive heart failure with New York Heart Association functional classification > II, characterized by fatigue, dyspnea or other symptoms which limit activities of daily life.

Selection of Pemetrexed versus Gemcitabine: Patients treated with pemetrexed must meet all of the following criteria:

• Non-squamous histology
• Patients must have the ability to interrupt non-steroidal anti-inflammatory drugs (NSAIDs) 2 days before (5 days for long-acting NSAIDs), the day of, and 2 days following administration of pemetrexed
• Patients must have the ability to take folic acid, Vitamin B12, and dexamethasone according to protocol
• Patient refuses to take cisplatin

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: pemetrexed plus cisplatin, vinorelbine and docetaxel; This is a phase 2 clinical trial for patients with clinical Stage IB-III resectable and operable non-small cell lung cancer, evaluating whether the switch to an alternative, non-platinum neoadjuvant chemotherapy is safe and effective in patients who do not respond to neoadjuvant platinum-based chemotherapy. Those who fail to respond to platinum-based chemotherapy will be switched to the alternative neoadjuvant chemotherapy vinorelbine 45 mg/m2 and docetaxel 45 mg/m2 on day 1 followed by pegylated filgrastim on day 2, repeated every 2 weeks for 4 doses, followed by repeat FDG PET and CT scan.

Drug: Docetaxel; Drug: cisplatin; Drug: Carboplatin; Drug: Gemcitabine Hydrochloride; Drug: pemetrexed; Drug: Vinorelbine Tartrate

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
PERCIST Partial Metabolic Response	The primary endpoint was partial metabolic response after 2 cycles of "switch" therapy as assessed by PERCIST (SUVmax decrease ≥30% using the pre-switch scan as new baseline).	2 years

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pathologic Response Rate	The percentage of patients with a major pathologic response	2 years

Collaborators and Investigators

• Sponsor: Memorial Sloan Kettering Cancer Center
• Collaborators: Eli Lilly and Company; United States Department of Defense

Publications and helpful links

Helpful Links

• Memorial Sloan-Kettering Cancer Center

Study record dates

Study Major Dates

• Study Start: October 1, 2011
• Primary Completion (ACTUAL): April 1, 2015
• Study Completion (ACTUAL): April 1, 2015

Study Registration Dates

• First Submitted: September 26, 2011
• First Submitted That Met QC Criteria: September 27, 2011
• First Posted (ESTIMATE): September 29, 2011

Study Record Updates

• Last Update Posted (ACTUAL): August 9, 2018
• Last Update Submitted That Met QC Criteria: July 12, 2018
• Last Verified: July 1, 2018

More Information

Terms related to this study

• Keywords: non-small cell lung cancer; Cisplatin; Carboplatin; Taxotere (Docetaxel); non squamous; Pemetrexed (Altima); Vinorelbine Tartrate (Navelbine); Stage IB-III; 11-106
• Additional Relevant MeSH Terms: Respiratory Tract Diseases; Neoplasms; Lung Diseases; Neoplasms by Site; Respiratory Tract Neoplasms; Thoracic Neoplasms; Carcinoma, Bronchogenic; Bronchial Neoplasms; Lung Neoplasms; Carcinoma, Non-Small-Cell Lung; Physiological Effects of Drugs; Molecular Mechanisms of Pharmacological Action; Anti-Infective Agents; Antiviral Agents; Nucleic Acid Synthesis Inhibitors; Enzyme Inhibitors; Antimetabolites, Antineoplastic; Antimetabolites; Antineoplastic Agents; Immunosuppressive Agents; Immunologic Factors; Tubulin Modulators; Antimitotic Agents; Mitosis Modulators; Antineoplastic Agents, Phytogenic; Folic Acid Antagonists; Gemcitabine; Docetaxel; Carboplatin; Cisplatin; Vinorelbine; Pemetrexed
• Other Study ID Numbers: 11-106