Pharmacogenomic & Phase II Study of Gemcitabine and Pemetrexed in Non-Small-Cell Lung Cancer.
Phase II Study of Neoadjuvant Chemotherapy With Gemcitabine and Pemetrexed in Resectable Non-Small-Cell Lung Cancer (NSCLC) With Pharmacogenomic Correlates.
調査の概要
詳細な説明
This study will evaluate the efficacy and safety of neoadjuvant chemotherapy with gemcitabine and pemetrexed given together 4-times biweekly in patients with resectable NSCLC. All patients will be seen by members of the Thoracic Oncology Program at the H. Lee Moffitt Cancer Center and Research Institute in Tampa, Florida, and they will be discussed in our weekly multidisciplinary thoracic oncology conference. The conference includes pathologists, radiologists, thoracic surgeons, pulmonologists, radiation oncologists, medical oncologists, oncology nurse specialists, case managers, social workers, and clinical trials coordinators. They will have initial tests as outlined in the study timetable. Patients will receive gemcitabine biweekly on days 1, 15, 29, and 43 at a dose of 1,500 mg/m2. They will also receive pemetrexed at a dose of 500 mg/m2 on days 1, 15, 29, and 43. Gemcitabine will be given first over a period of 30 minutes i.v. followed by pemetrexed over 10 minutes i.v. All patients will get a post induction chemotherapy PET scan, CT scan, and PFT's including a DLCO. They will then go on to thoracotomy including bronchoscopy and mediastinal lymph node dissection between days 64 and 77 if the tumor is deemed completely resectable on restaging studies.
The administration of chemotherapy at the earliest time (neoadjuvant or induction chemotherapy) following diagnosis in an effort to reduce the risk of disease recurrence. This approach also allows for investigations of molecular parameters that may affect response to chemotherapy and patients' survival. It is our hypothesis that the expression of genes associated with activation, inactivation, and efficacy of the drugs gemcitabine and pemetrexed will predict response to therapy and prognosis. We further hypothesize that the expression of these genes will be altered during chemotherapy, and that the global assessment of tumor proliferation, apoptosis, and genome damage is associated with response to therapy. We propose a phase II study of neoadjuvant chemotherapy with gemcitabine and pemetrexed in patients with resectable NSCLC, specifically correlating molecular and genetic parameters to the primary clinical study endpoint disease response (radiographic CR+PR) and the secondary endpoints complete pathological response at surgery, disease-free survival, and overall survival.
研究の種類
入学 (実際)
段階
- フェーズ2
連絡先と場所
研究場所
-
-
Florida
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Tampa、Florida、アメリカ、33612
- H. Lee Moffitt Cancer Center & Research Institute
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-
参加基準
適格基準
就学可能な年齢
健康ボランティアの受け入れ
受講資格のある性別
説明
Inclusion Criteria:
- Microscopically confirmed non-small cell carcinoma of the lung, which may be confirmed at the initial bronchoscopy and mediastinoscopy, or by transthoracic needle biopsy.
- No prior therapy for lung cancer.
- Patients must have disease stages IB (T2N0M0), IIA (T1N1M0), IIB (T2N1M0 and T3N0M0), or IIIA (T3N1M0 and T1-3N2M0). Patients with 2 lesions in one lobe (T4) (Stage IIIB) are eligible.
- Patients must be deemed medically fit for surgical resection by a thoracic surgeon.
- Patients must have an ECOG performance status of Zero or One.
- Patients must have measurable or evaluable disease.
- Measurable Disease: Any mass reproducibly measurable in one diameter (RECIST criteria).
- Evaluable disease: Lesions apparent on chest CT, which do not meet the criteria for measurability. These include ill-defined masses associated with post obstructive changes.
- Age >18 years.
- Patient must be able to understand and sign the informed consent.
- Patients must be >12 weeks from prior major surgery, such as a coronary artery bypass graft.
Exclusion Criteria:
- White blood cell count <3000/mm3
- Platelet count <100,000/mm3
- Hemoglobin <9.0 g/dl
- Creatinine >1.5 mg/dl
- Total bilirubin >1.5 mg/dl
- SGOT, SGPT, or AP >1.5 x upper limit of normal
- Metastatic disease (except peribronchial/hilar lymph nodes=N1 and ipsilateral/subcarinal mediastinal lymph nodes=N2) or malignant pleural effusion detected on preoperative evaluation. Non-malignant effusions are cytology negative, are non-bloody, and are transudates. Effusions visible only on CT and not large enough for safe thoracentesis will not result in ineligibility. Exudative effusions, even if cytologically negative are excluded. Pleural fluid is considered exudative if: the ratio of pleural fluid protein to serum protein is >0.5 or the ratio of pleural fluid LDH to serum to serum LDH >0.6 or Pleural fluid LDH is >200 IU/liter. A staging PET scan will be used to exclude patients. If there are multiple areas of FDG uptake outside the area of the primary tumor and the hilar and ipsilateral mediastinal lymph nodes, the patient will be excluded by virtue of having metastatic disease. If however, only one area shows an increase in FDG uptake, the area of concern will need further evaluation such as a biopsy to exclude metastatic disease.
- N3 lymph nodes (contralateral mediastinal/hilar and supraclavicular/scalene) or T4 primary tumor (malignant pleural effusion or mediastinal invasion) by clinical staging criteria (N3 as seen on CT or PET scan, which may be proven by mediastinoscopy at the investigators discretion).
- Pregnancy.
- Other active malignancy within 2 years with the exceptions of non-melanoma skin cancer and cervical carcinoma in situ.
- Psychologic, familial, sociologic, or geographic conditions, which do not permit biweekly medical follow-up and adherence to the study protocol.
- Prior radiation therapy for any cancer to the thorax.
研究計画
研究はどのように設計されていますか？
デザインの詳細
- 主な目的：処理
- 割り当て：なし
- 介入モデル：単一グループの割り当て
- マスキング：なし（オープンラベル）
武器と介入
参加者グループ / アーム |
介入・治療 |
|---|---|
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実験的：Pre-Surgery Chemotherapy
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Gemcitabine (GemzarR) 1500 mg/m2
他の名前：
Pemetrexed (AlimtaR) 500 mg/m2
他の名前：
When the chemotherapy treatment is completed, the patient's tumor response will be evaluated by a CT scan, pulmonary function test, and another PET scan between days 50 and 63 (during weeks 8 and 9).
If there is no growth or spread of the cancer on any of these tests, patients will then proceed to have surgery by week 10 to remove the cancer.
|
この研究は何を測定していますか？
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
|
Disease Response - Radiographic
時間枠：06/20/2008 Index date for patients enrolled between 04/2004 and 04/2006
|
Number of participants with partial or Complete Response. Complete response (CR) is defined as the total disappearance of all malignant and evaluable clinical evidence of cancer without the development of any new malignant lesions documented on the post chemotherapy chest CT and PET scan. Partial response (PR) (measurable disease only): When compared with pre-treatment measurements, a reduction of >30% in the sum of the largest diameters of all measurable lesions and absence of new lesions. |
06/20/2008 Index date for patients enrolled between 04/2004 and 04/2006
|
二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
|
Disease Response - Pathologic
時間枠：06/20/2008 Index date for patients enrolled between 04/2004 and 04/2006
|
Number of participants with Pathologic Complete Response.
Pathologic complete response (pCR) is defined by a surgical pathology specimen, which consists of equal to or more than 95% fibrosis and necrosis.
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06/20/2008 Index date for patients enrolled between 04/2004 and 04/2006
|
|
Survival - Disease Free
時間枠：06/20/2008 Index date for patients enrolled between 04/2004 and 04/2006
|
Disease-free survival (DFS) is defined as the period of time from surgery to the time when disease recurrence is clearly documented.
A histologic confirmation is required in equivalent cases.
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06/20/2008 Index date for patients enrolled between 04/2004 and 04/2006
|
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Survival - Overall
時間枠：06/20/2008 Index date for patients enrolled between 04/2004 and 04/2006
|
Median range of number of participants with Overall Survival.
Overall survival (OS) will be defined as the period of time from the first day of drug treatment to the date of death of the patient.
Patients taken off study will be followed quarterly until death for survival data.
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06/20/2008 Index date for patients enrolled between 04/2004 and 04/2006
|
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Toxicity
時間枠：06/20/2008 Index date for patients enrolled between 04/2004 and 04/2006
|
Number of participants with toxicity ≥ Grade 3 after gemcitabine plus pemetrexed induction chemotherapy.
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06/20/2008 Index date for patients enrolled between 04/2004 and 04/2006
|
協力者と研究者
捜査官
- 主任研究者：Gerold Bepler, M.D, Ph.D.、H. Lee Moffitt Cancer Center (now at Karmanos Cancer Institute)
出版物と役立つリンク
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主要日程の研究
研究開始
一次修了 (実際)
研究の完了 (実際)
試験登録日
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QC基準を満たした最初の提出物
最初の投稿 (見積もり)
学習記録の更新
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最終確認日
詳しくは
この情報は、Web サイト clinicaltrials.gov から変更なしで直接取得したものです。研究の詳細を変更、削除、または更新するリクエストがある場合は、register@clinicaltrials.gov。 までご連絡ください。 clinicaltrials.gov に変更が加えられるとすぐに、ウェブサイトでも自動的に更新されます。
肺癌の臨床試験
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