Dose-Dense Induction/Neoadjuvant Chemotherapy in Locally Advanced Non-Small Cell Lung Cancer

Dose-Dense Induction/Neoadjuvant Chemotherapy in the Treatment of Patients With Locally Advanced Non-Small Cell Lung Cancer With Additional Genomic Analyses to Identify Signatures Predictive of Chemotherapy Response.

Dose-dense chemotherapy is a chemotherapy treatment plan in which drugs are given with less time between treatments than in standard chemotherapy. The two chemotherapy drugs used in this study, docetaxel and cisplatin, are approved for the treatment of lung cancer when given every 21 days. This study is exploring the response to chemotherapy when these drugs are given every 14 days. In addition, genetic tests will be performed on pre-treatment specimens to identify signatures that may predict chemotherapy sensitivity or resistance.

Study Overview

• Status: Terminated
• Conditions: Non-small Cell Lung Cancer
• Intervention / Treatment: Drug: Docetaxel; Drug: cisplatin; Drug: Pegfilgrastim

Detailed Description

All patients will receive induction chemotherapy with cisplatin and docetaxel. Pegfilgrastim will be administered approximately 24 hours following the end of the day 1 chemotherapy infusion. Cycles will be repeated every 2 weeks for 3 cycles. Patients deemed to be resectable will undergo surgical resection followed by postoperative thoracic radiotherapy. Patients deemed inoperable will additionally receive concurrent chemoradiotherapy. Response, using radiographic and/or pathologic means, will identify two cohorts; responders and nonresponders.Gene expression profiling will then be performed on pre-treatment specimens to identify signatures that predict for chemotherapy sensitivity or resistance.

The target enrollment is 45 patients.

• Study Type: Interventional
• Enrollment (Actual): 13
• Phase: Phase 2

Contacts and Locations

Study Locations

• United States
  • North Carolina
    • Durham, North Carolina, United States, 27710
      • Duke University Medical 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:

• Patients with documented stage III NSCLC (IIIA or IIIB, without malignant pleural/pericardial effusion) are eligible for enrollment if they are considered appropriate for treatment with chemotherapy, radiation, or surgery;
• IIIA: T1-3 N2 M0, T3 N1 M0
• IIIB: T4 N0-2 M0, T 1-4 N3 M0
• Measurable or evaluable disease
• Previously untreated with chemotherapy or radiotherapy for lung cancer;
• No brain metastases;
• No prior XRT
• Performance status 0-2
• ≥18 years of age
• Informed Consent
• Absolute neutrophil count (ANC) ≥ 1.5 x 109/L
• Platelets ≥ 100 x 109/L
• Bilirubin ≤ 1.5 x upper limit of normal for the institution (ULN)
• SGOT and SGPT ≤ 2.5 x ULN for the institution
• Creatinine ≤ 1.6 mg/dL
• Hemoglobin ≥ 8.0 g/dL
• Peripheral neuropathy ≤ grade 1

Exclusion Criteria:

• Known sensitivity to E. coli derived products (e.g. Filgrastim, HUMULIN® insulin, L-asparaginase, HUMATROPE® Growth Hormone, INTRON® A);
• Use of IV systemic antibiotics within 72 hours prior to chemotherapy;
• Known HIV infection
• Lithium or cytokines within 2 weeks prior of entry
• Additional concurrent investigational drugs
• History of myelodysplastic syndrome
• Pregnant, nursing or having unprotected sex
• Not available for follow-up assessment
• Unable to comply with protocol procedures
• Illnesses that may compromise ability to give informed consent.
• Patients with a history of severe hypersensitivity reaction to Taxotere® or other drugs formulated with polysorbate 80.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Induction Chemotherapy; Cisplatin 75mg/m2 IV days 1, 15, 29; Docetaxel 75mg/m2 IV days 1, 15, 29; and Pegfilgrastim 6mg SC day 2, 16, 30	Drug: Docetaxel; Other Names: Taxotere; Drug: cisplatin; Other Names: Platinol; Drug: Pegfilgrastim; Other Names: Neulasta

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Induction Response	Response will be assessed using the Response Evaluation Criteria in Solid Tumors (RECIST) criteria. Response is defined as the number patients with a Complete Response (CR), disappearance of all target lesions, or a Partial Response (PR), at least a 30% decrease in the sum of the longest diameter (LD) of target lesions.	Between 2 and 3 weeks after induction
Differential Gene Expression Between Responsive and Resistant Tumor Treated With Dose-dense Therapy		at the end of the study, estimated 2.5 years

Secondary Outcome Measures

Outcome Measure	Time Frame
Number of Grade III/IV Hematologic Adverse Events	During induction chemotherapy, approximately 6 weeks
Number of Grade III/IV Non-hematologic Adverse Events	During induction chemotherapy, approximately 6 weeks
Number of Patients Who Were Able to Maintain Hemoglobin Between 11-13 g/dL During Induction	During induction, approximately 6 weeks
Overall Survival	Approximately 10 years

Collaborators and Investigators

• Sponsor: Duke University
• Collaborators: Sanofi

Study record dates

Study Major Dates

• Study Start: May 1, 2006
• Primary Completion (Actual): October 1, 2009
• Study Completion (Actual): January 1, 2010

Study Registration Dates

• First Submitted: May 29, 2014
• First Submitted That Met QC Criteria: June 2, 2014
• First Posted (Estimate): June 5, 2014

Study Record Updates

• Last Update Posted (Estimate): July 4, 2014
• Last Update Submitted That Met QC Criteria: June 5, 2014
• Last Verified: June 1, 2014

More Information

Terms related to this study

• Keywords: Dose-Dense Chemotherapy
• 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; Molecular Mechanisms of Pharmacological Action; Antineoplastic Agents; Tubulin Modulators; Antimitotic Agents; Mitosis Modulators; Docetaxel; Cisplatin
• Other Study ID Numbers: Pro00004682