Radiation Therapy and Stereotactic Radiosurgery With or Without Temozolomide or Erlotinib in Treating Patients With Brain Metastases Secondary to Non-Small Cell Lung Cancer
A Phase III Trial Comparing Whole Brain Radiation and Stereotactic Radiosurgery Alone Versus With Temozolomide or Erlotinib in Patients With Non-Small Cell Lung Cancer and 1-3 Brain Metastases
Panoramica dello studio
Stato
Stato
Condizioni
Condizioni
Intervento / Trattamento
Intervento / Trattamento
Descrizione dettagliata
PRIMARY OBJECTIVES:
I. Compare survival in patients with non-small cell lung cancer and brain metastases treated with whole brain radiotherapy and stereotactic radiosurgery with vs without temozolomide or erlotinib.
SECONDARY OBJECTIVES:
I. Compare time to CNS progression in patients treated with these regimens. II. Compare quality-adjusted survival in patients treated with these regimens. III. Compare 3-month quality of life in patients treated with these regimens. IV. Compare the 6-month performance status of patients treated with these regimens.
V. Compare 6-month steroid dependence in patients treated with these regimens. VI. Compare cause of death (neurologic vs other) in patients treated with these regimens.
VII. Determine the effects of non-protocol chemotherapy in these patients.
OUTLINE: This is a randomized, multicenter study. Patients are stratified according to age and the presence of extracranial metastases (< 65 years old AND no extracranial metastases vs ≥ 65 years old OR extracranial metastases), number of metastases (1 vs 2 or 3), and extent of extracranial disease (none vs present). Patients are randomized to 1 of 3 treatment arms.
ARM I: Patients undergo whole brain radiotherapy (WBRT) once daily on days 1-5, 8-12, and 15-19. Within 14 days after completion of WBRT, patients undergo stereotactic radiosurgery.
ARM II: Patients undergo WBRT and stereotactic radiosurgery as in arm I. Beginning on the first day of WBRT, patients receive oral temozolomide once daily on days 1-21. Beginning 4 weeks after completion of WBRT, patients may receive oral temozolomide alone once daily on days 1-5. Treatment with temozolomide repeats every 28 days for up to 6 courses in the absence of disease progression or unacceptable toxicity.
ARM III: Patients undergo WBRT and stereotactic radiosurgery as in arm I. Beginning on the first day of WBRT, patients receive oral erlotinib once daily for up to 6 months.
In all arms, patients with recurrent brain metastases may undergo additional stereotactic radiosurgery.
Quality of life is assessed at baseline and at 3, 6, 9, 12, 18, and 24 months.
Patients are followed every 3 months for 2 years, every 6 months for 2 years, and then annually thereafter.
Tipo di studio
Tipo di studio
Iscrizione (Effettivo)
Iscrizione
Fase
Fase
- Fase 3
Contatti e Sedi
Luoghi di studio
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Manitoba
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Winnipeg, Manitoba, Canada, R3E 0V9
- CancerCare Manitoba
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Ontario
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Ottawa, Ontario, Canada, K1Y 4E9
- Ottawa Hospital-Civic Campus
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Quebec
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Montreal, Quebec, Canada, H2W 1S6
- McGill University Department of Oncology
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Arizona
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Scottsdale, Arizona, Stati Uniti, 85260
- Arizona Oncology Services Foundation
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Scottsdale, Arizona, Stati Uniti, 85260
- Scottsdale Health Care-Osborn
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California
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Burbank, California, Stati Uniti, 91505
- Providence Saint Joseph Medical Center/Disney Family Cancer Center
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Los Angeles, California, Stati Uniti, 90027
- Kaiser Permanente Los Angeles Medical Center
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Pomona, California, Stati Uniti, 91767
- Pomona Valley Hospital Medical Center
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Colorado
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Grand Junction, Colorado, Stati Uniti, 81501
- Saint Mary's Hospital and Regional Medical Center
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Delaware
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Newark, Delaware, Stati Uniti, 19718
- Christiana Care Health System-Christiana Hospital
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Florida
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Jacksonville, Florida, Stati Uniti, 32207
- Baptist MD Anderson Cancer Center
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Jacksonville, Florida, Stati Uniti, 32258
- Baptist Medical Center South
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Jacksonville, Florida, Stati Uniti, 32207
- Integrated Community Oncology Network-Southside Cancer Center
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Jacksonville Beach, Florida, Stati Uniti, 32250
- Integrated Community Oncology Network-Florida Cancer Center Beaches
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Miami, Florida, Stati Uniti, 33136
- University of Miami Miller School of Medicine-Sylvester Cancer Center
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Orange Park, Florida, Stati Uniti, 32073
- 21st Century Oncology-Orange Park
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Orlando, Florida, Stati Uniti, 32806
- UF Cancer Center at Orlando Health
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Palatka, Florida, Stati Uniti, 32177
- 21st Century Oncology-Palatka
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Panama City, Florida, Stati Uniti, 32401
- Bay Medical Center
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Saint Augustine, Florida, Stati Uniti, 32086
- Integrated Community Oncology Network-Flager Cancer Center
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Tallahassee, Florida, Stati Uniti, 32308
- Tallahassee Memorial HealthCare
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Georgia
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Columbus, Georgia, Stati Uniti, 31904
- John B Amos Cancer Center
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Idaho
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Boise, Idaho, Stati Uniti, 83706
- Saint Alphonsus Cancer Care Center-Boise
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Illinois
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Arlington Heights, Illinois, Stati Uniti, 60005
- Northwest Community Hospital
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Chicago, Illinois, Stati Uniti, 60611
- Northwestern University
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Harvey, Illinois, Stati Uniti, 60426
- Ingalls Memorial Hospital
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Springfield, Illinois, Stati Uniti, 62702
- Saint John's Hospital
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Indiana
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Fort Wayne, Indiana, Stati Uniti, 46805
- Parkview Hospital Randallia
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Hammond, Indiana, Stati Uniti, 46320
- Franciscan Saint Margaret Health-Hammond Campus
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Indianapolis, Indiana, Stati Uniti, 46202
- IU Health Methodist Hospital
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Iowa
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Dubuque, Iowa, Stati Uniti, 52001
- Finley Hospital
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Kentucky
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Louisville, Kentucky, Stati Uniti, 40207
- Norton Suburban Hospital and Medical Campus
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Maryland
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Baltimore, Maryland, Stati Uniti, 21201
- University of Maryland/Greenebaum Cancer Center
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Baltimore, Maryland, Stati Uniti, 21229
- Saint Agnes Hospital
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Massachusetts
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Boston, Massachusetts, Stati Uniti, 02114
- Massachusetts General Hospital Cancer Center
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Michigan
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Ann Arbor, Michigan, Stati Uniti, 48109
- University Of Michigan Comprehensive Cancer Center
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Detroit, Michigan, Stati Uniti, 48201
- Wayne State University/Karmanos Cancer Institute
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Kalamazoo, Michigan, Stati Uniti, 49007
- West Michigan Cancer Center
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Minnesota
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Burnsville, Minnesota, Stati Uniti, 55337
- Fairview Ridges Hospital
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Coon Rapids, Minnesota, Stati Uniti, 55433
- Mercy Hospital
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Edina, Minnesota, Stati Uniti, 55435
- Fairview-Southdale Hospital
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Fridley, Minnesota, Stati Uniti, 55432
- Unity Hospital
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Minneapolis, Minnesota, Stati Uniti, 55407
- Abbott-Northwestern Hospital
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Minneapolis, Minnesota, Stati Uniti, 55455
- University of Minnesota/Masonic Cancer Center
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Robbinsdale, Minnesota, Stati Uniti, 55422
- North Memorial Medical Health Center
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Saint Cloud, Minnesota, Stati Uniti, 56303
- Coborn Cancer Center at Saint Cloud Hospital
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Saint Cloud, Minnesota, Stati Uniti, 56303
- Saint Cloud Hospital
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Saint Louis Park, Minnesota, Stati Uniti, 55416
- Park Nicollet Clinic - Saint Louis Park
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Saint Louis Park, Minnesota, Stati Uniti, 55416
- Metro Minnesota Community Oncology Research Consortium
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Saint Paul, Minnesota, Stati Uniti, 55102
- United Hospital
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Waconia, Minnesota, Stati Uniti, 55387
- Ridgeview Medical Center
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Missouri
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Saint Louis, Missouri, Stati Uniti, 63110
- Saint Louis University Hospital
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Nevada
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Las Vegas, Nevada, Stati Uniti, 89106
- Nevada Cancer Research Foundation CCOP
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Reno, Nevada, Stati Uniti, 89502
- Renown Regional Medical Center
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New Jersey
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New Brunswick, New Jersey, Stati Uniti, 08903
- Rutgers Cancer Institute of New Jersey-Robert Wood Johnson University Hospital
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Red Bank, New Jersey, Stati Uniti, 07701
- Riverview Medical Center/Booker Cancer Center
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Sparta, New Jersey, Stati Uniti, 07871
- Sparta Cancer Treatment Center
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New York
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Rochester, New York, Stati Uniti, 14642
- University of Rochester
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North Carolina
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Asheville, North Carolina, Stati Uniti, 28801
- Mission Hospital-Memorial Campus
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Ohio
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Akron, Ohio, Stati Uniti, 44304
- Summa Akron City Hospital/Cooper Cancer Center
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Cleveland, Ohio, Stati Uniti, 44195
- Cleveland Clinic Foundation
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Oklahoma
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Tulsa, Oklahoma, Stati Uniti, 74136
- Natalie Warren Bryant Cancer Center at Saint Francis
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Pennsylvania
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Drexel Hill, Pennsylvania, Stati Uniti, 19026
- Delaware County Memorial Hospital
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Philadelphia, Pennsylvania, Stati Uniti, 19111
- Fox Chase Cancer Center
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Philadelphia, Pennsylvania, Stati Uniti, 19107
- Thomas Jefferson University Hospital
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Philadelphia, Pennsylvania, Stati Uniti, 19103
- Radiation Therapy Oncology Group
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West Reading, Pennsylvania, Stati Uniti, 19611
- Reading Hospital
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South Carolina
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Charleston, South Carolina, Stati Uniti, 29425
- Medical University of South Carolina
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Tennessee
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Knoxville, Tennessee, Stati Uniti, 37916
- Thompson Cancer Survival Center
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Texas
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Arlington, Texas, Stati Uniti, 76012
- Arlington Cancer Center
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Dallas, Texas, Stati Uniti, 75390
- UT Southwestern/Simmons Cancer Center-Dallas
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Galveston, Texas, Stati Uniti, 77555-0565
- University of Texas Medical Branch
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Houston, Texas, Stati Uniti, 77030
- M D Anderson Cancer Center
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Utah
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Murray, Utah, Stati Uniti, 84107
- Intermountain Medical Center
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Ogden, Utah, Stati Uniti, 84403
- McKay-Dee Hospital Center
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Salt Lake City, Utah, Stati Uniti, 84112
- Huntsman Cancer Institute/University of Utah
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Salt Lake City, Utah, Stati Uniti, 84143
- LDS Hospital
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Virginia
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Norfolk, Virginia, Stati Uniti, 23507
- Sentara Norfolk General Hospital
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Richmond, Virginia, Stati Uniti, 23298
- Virginia Commonwealth University/Massey Cancer Center
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Washington
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Seattle, Washington, Stati Uniti, 98101
- Virginia Mason Medical Center
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Wisconsin
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Madison, Wisconsin, Stati Uniti, 53792
- University of Wisconsin Hospital and Clinics
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Milwaukee, Wisconsin, Stati Uniti, 53226
- Froedtert and The Medical College of Wisconsin
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Racine, Wisconsin, Stati Uniti, 53405
- Wheaton Franciscan Cancer Care - All Saints
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Criteri di partecipazione
Criteri di ammissibilità
Criteri di ammissibilità
Età idonea allo studio
Accetta volontari sani
Sessi ammissibili allo studio
Descrizione
Inclusion Criteria:
- Histologically confirmed non-small cell lung cancer
One to 3 intraparenchymal brain metastases by contrast-enhanced MRI, meeting the following criteria:
- Well circumscribed tumor(s)
Maximum diameter ≤ 4.0 cm
- If multiple lesions are present and one lesion is at the maximum diameter, the other lesions must not exceed 3.0 cm in maximum diameter
- No metastases within 10 mm of the optic apparatus such that a portion of the optic nerve or chiasm would be included in the high-dose stereotactic radiosurgery boost field
- No metastases in the brainstem, midbrain, pons, or medulla
No prior complete resection of all known brain metastases
- Subtotal resection allowed provided residual disease is ≤ 4.0 cm in maximum diameter
No clinical or radiographic evidence of progression (other than study lesion[s]) within the past month
- Patients with brain metastases at initial presentation do not require 1 month of scans documenting stable disease
Stable extracranial metastases allowed
- No known or pre-existing liver metastases
- No leptomeningeal metastases by MRI or cerebrospinal fluid evaluation
- Synchronous brain metastases at initial diagnosis allowed
- Performance status - Zubrod 0-1
- Hemoglobin ≥ 8 g/dL
- Absolute neutrophil count ≥ 1,000/mm^3
- Platelet count ≥ 100,000/mm^3
- AST < 2 times upper limit of normal (ULN)
- Alkaline phosphatase < 2 times ULN unless due to elevated bone metastases
- Total bilirubin normal
- Lactic dehydrogenase < 2 times ULN
- Creatinine < 1.5 times ULN
No clinically active interstitial lung disease
- Chronic stable asymptomatic radiographic changes allowed
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception
- HIV negative
- Neurologic function status 0-2
- No other major medical illness or psychiatric impairment that would preclude study participation
- No history of allergic reaction attributed to compounds of similar chemical or biologic composition to erlotinib or temozolomide
- No concurrent immunotherapy
- No concurrent biologic therapy, excluding growth factors and epoetin alfa
- No prior temozolomide or erlotinib
No other concurrent chemotherapy during study radiotherapy
Other concurrent chemotherapy allowed after study radiotherapy, except for the following:
- Temozolomide or erlotinib (arm I only)
- Erlotinib (arm II only)
- Temozolomide (arm III only)
- No prior cranial radiotherapy
- No concurrent intensity-modulated radiotherapy
Concurrent radiotherapy to painful bone lesions allowed
- No concurrent radiotherapy to more than 15% of bone marrow
- No other concurrent therapy for brain metastases unless a recurrence is detected
- More than 30 days since prior investigational drugs
No concurrent enzyme-inducing antiepileptic drugs including, but not limited to, any of the following (for patients randomized to receive erlotinib):
- Phenytoin
- Carbamazepine
- Rifampin
- Phenobarbital
- Primidone
- Oxcarbazepine
- No other concurrent investigational drugs
- No concurrent Hypericum perforatum (St. John's wort)
- No drugs that alter gastric pH (e.g., proton pump inhibitors or H2 antagonists) within 4 hours after erlotinib administration (arm III patients only)
Piano di studio
Come è strutturato lo studio?
Dettagli di progettazione
- Scopo principale: Trattamento
- Assegnazione: Randomizzato
- Modello interventistico: Assegnazione parallela
- Mascheramento: Nessuno (etichetta aperta)
Numero di armi
Armi e interventi
Gruppo di partecipanti / ArmGruppo di partecipanti / Arm |
Intervento / TrattamentoIntervento / Trattamento |
|---|---|
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Comparatore attivo: Arm I
Patients undergo whole brain radiotherapy (WBRT) once daily on days 1-5, 8-12, and 15-19.
Within 14 days after completion of WBRT, patients undergo stereotactic radiosurgery.
|
Patients undergo radiation therapy once daily for approximately 3 weeks
Altri nomi:
Patients undergo surgery after radiation therapy
Altri nomi:
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Sperimentale: Arm II
Patients undergo WBRT and stereotactic radiosurgery as in arm I. Beginning on the first day of WBRT, patients receive oral temozolomide once daily on days 1-21.
Beginning 4 weeks after completion of WBRT, patients may receive oral temozolomide alone once daily on days 1-5.
Treatment with temozolomide repeats every 28 days for up to 6 courses in the absence of disease progression or unacceptable toxicity.
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Dato oralmente
Altri nomi:
Patients undergo radiation therapy once daily for approximately 3 weeks
Altri nomi:
Patients undergo surgery after radiation therapy
Altri nomi:
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Sperimentale: Arm III
Patients undergo WBRT and stereotactic radiosurgery as in arm I. Beginning on the first day of WBRT, patients receive oral erlotinib once daily for up to 6 months.
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Dato oralmente
Altri nomi:
Patients undergo radiation therapy once daily for approximately 3 weeks
Altri nomi:
Patients undergo surgery after radiation therapy
Altri nomi:
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Cosa sta misurando lo studio?
Misure di risultato primarie
Misure di risultato primarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
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Overall Survival
Lasso di tempo: From randomization to date of death or last follow-up, up to 48.1 months. Analysis occurs after all patients have been potentially followed for 9 months.
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Survival time is defined as time from randomization to date of death from any cause and estimated by the Kaplan-Meier method.
Patients last known to be alive are censored at date of last contact.
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From randomization to date of death or last follow-up, up to 48.1 months. Analysis occurs after all patients have been potentially followed for 9 months.
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Misure di risultato secondarie
Misure di risultato secondarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
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Rate of CNS Progression (One Year)
Lasso di tempo: From randomization to last follow-up, up to 48.1 months. Analysis occurs after all patients have been potentially followed for 9 months.
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CNS progression is defined as any increase in perpendicular bi-dimensional tumor area for any of the 1-3 tracked brain metastases, by any amount, or the appearance of any new brain metastasis on a follow-up MRI (SRS planning scan will not be used to evaluate CNS progression).
For lesions smaller than 1 cm in maximum diameter, a maximum increase of 50% in perpendicular bi-dimensional treatment area is necessary to score as progression.
This caveat is included to account for potential variability in measurement, which is most susceptible to proportionate errors at smaller sizes.
For greater than 1 cm lesions, the definition uses a 25% rule for change.
Rates of CNS progression estimated by the cumulative incidence method, with death treated as a competing risk.
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From randomization to last follow-up, up to 48.1 months. Analysis occurs after all patients have been potentially followed for 9 months.
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Quality-adjusted Survival as Measured by EuroQol 5-dimension Instrument
Lasso di tempo: From randomization to last follow-up, up to 48.1 months. Analysis occurs after all patients have been potentially followed for 9 months.
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Quality-adjusted life years (QALY) incorporate the societal-based utilities of health states into expected life years for a health condition.
The QALY model is QALY(h,y) where h is a health state and y is the years of life.
Higher quality-adjusted life year values represent a better outcome.
A patient's health state will be determined from the index score of the EQ-5D-5L patient questionnaire.The EQ-5D-5L is a 2-part self-assessment questionnaire, a 5-item index score and a visual analogue scale, but only the index score is used for quality-adjusted survival.
The index score has 5 items (mobility, self care, usual activities, pain/discomfort, anxiety/depression) each with 5 problem levels (1-none to 5-extreme).
The 5-item index score is transformed into a utility score between 0 (worst health state) and 1 (best health state).
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From randomization to last follow-up, up to 48.1 months. Analysis occurs after all patients have been potentially followed for 9 months.
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Change in Functional Assessment of Cancer Therapy-Brain (FACT-Br) Score at 3 Months
Lasso di tempo: From randomization to three months.
|
The Functional Assessment of Cancer Therapy-Brain (FACT-Br) is a 19-item self-report instrument designed to measure multidimensional quality of life in patients with brain cancer.
It is to be administered with the FACT-General.
There are 5 responses options, with 0=Not a lot and 4=Very much.
All items are added together to obtain a total score, which ranges from 0 to 76. Certain items must be reversed before it is added by subtracting the response from 4. It requires at least 50% of the items to be completed while the overall response rate of the FACT-Br including the FACT-G must be greater than 80%.
If items are missing, the subscale scores can be prorated.
A higher score indicates better QOL.
A change of 5 points will be considered a minimal clinically meaningful change.
Change from baseline at three months (3 month score - baseline score) will be categorized as improvement if increased, stable if no change, or deterioration if decreased.
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From randomization to three months.
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Change in Performance Status at Six Months
Lasso di tempo: From randomization to six months.
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Compared between two treatment arms using a two-group chi-squared test.
Zubrod score will be collected at baseline and follow-up.
The Zubrod performance score runs from 0 to 5, with 0 denoting perfect health and 5 death.
Change from baseline is calculated as 6-month value - baseline value.
Patients with a baseline score who have died by six months will be included in the analysis with a score of 5 at six months.
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From randomization to six months.
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Change in Steroid Dependence at Six Months
Lasso di tempo: From randomization to six months.
|
Daily steroid dose will be collected at baseline and follow-up, as one of the following: 0-4 mg, >4 to ≤ 8 mg, >8 to ≤12 mg, and >12 mg.
Change from baseline at six months will be evaluated to have decreased, remained stable, or increased, based on these categories.
|
From randomization to six months.
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Cause of Death (Neurologic vs Other)
Lasso di tempo: From randomization to last follow-up, up to 48.1 months. Analysis occurs after all patients have been potentially followed for 9 months.
|
Patients were considered to have died neurologic deaths (coded as "Brain Metastases") if they had stable systemic disease and progressive neurologic disease consisting of expanding intracranial masses, CNS hemorrhages, hydrocephalus resulting in herniation or fulminant meningeal carcinomatosis.
|
From randomization to last follow-up, up to 48.1 months. Analysis occurs after all patients have been potentially followed for 9 months.
|
Collaboratori e investigatori
Sponsor
Sponsor
Collaboratori
Collaboratori
Investigatori
Investigatori
- Investigatore principale: Paul Sperduto, Radiation Therapy Oncology Group
Studiare le date dei record
Studia le date principali
Inizio studio (Effettivo)
Inizio studio
Completamento primario (Effettivo)
Completamento primario
Completamento dello studio (Effettivo)
Completamento dello studio
Date di iscrizione allo studio
Primo inviato
Primo inviato
Primo inviato che soddisfa i criteri di controllo qualità
Primo inviato che soddisfa i criteri di controllo qualità
Primo Inserito (Stima)
Primo Inserito
Aggiornamenti dei record di studio
Ultimo aggiornamento pubblicato (Effettivo)
Ultimo aggiornamento pubblicato
Ultimo aggiornamento inviato che soddisfa i criteri QC
Ultimo aggiornamento inviato che soddisfa i criteri QC
Ultimo verificato
Ultimo verificato
Maggiori informazioni
Termini relativi a questo studio
Termini MeSH pertinenti aggiuntivi
- Malattie del cervello
- Malattie del sistema nervoso centrale
- Malattie del sistema nervoso
- Malattie delle vie respiratorie
- Malattie polmonari
- Neoplasie per sede
- Neoplasie delle vie respiratorie
- Neoplasie toraciche
- Carcinoma, broncogeno
- Neoplasie bronchiali
- Neoplasie del sistema nervoso centrale
- Neoplasie del sistema nervoso
- Neoplasie
- Neoplasie polmonari
- Carcinoma, polmone non a piccole cellule
- Neoplasie cerebrali
- Meccanismi molecolari dell'azione farmacologica
- Inibitori enzimatici
- Agenti antineoplastici
- Agenti Antineoplastici, Alchilanti
- Agenti Alchilanti
- Inibitori della chinasi proteica
- Erlotinib cloridrato
- Temozolomide
Altri numeri di identificazione dello studio
Altri numeri di identificazione dello studio
- NCI-2009-00720 (Identificatore di registro: CTRP (Clinical Trial Reporting Program))
- U10CA021661 (Sovvenzione/contratto NIH degli Stati Uniti)
- CDR0000389490
- RTOG 0320 (Altro identificatore: Radiation Therapy Oncology Group)
- RTOG-0320 (Altro identificatore: CTEP)
Queste informazioni sono state recuperate direttamente dal sito web clinicaltrials.gov senza alcuna modifica. In caso di richieste di modifica, rimozione o aggiornamento dei dettagli dello studio, contattare register@clinicaltrials.gov. Non appena verrà implementata una modifica su clinicaltrials.gov, questa verrà aggiornata automaticamente anche sul nostro sito web .