Non-Small Cell Lung Cancer
Conditions
Keywords
Non-Small Cell Lung Cancer
Brief summary
Both pemetrexed and cetuximab have single agent activity in NSCLC and non-overlapping toxicity profiles. While 2-drug combination therapy has proven superior to single agent therapy in the first-line setting of NSCLC, no such phase III trials have been reported in the second-line setting. Therefore, the purpose of this study is to determine the feasibility of combining these drugs, assessing the toxicity profile, determining the MTD and evaluating the activity of the combination in an expanded phase II setting. If the combination appears to have promising activity, further evaluation of this regimen may be warranted comparing it to single agent pemetrexed or cetuximab alone.
Detailed description
OUTLINE: This is a multi-center study. Week 1 (day 1): * Cetuximab 400mg/m2 Week 2 (Cycle 1, Day 1): * Cetuximab 250mg/m2 plus premetrexed at the assigned dose level. Patients will be treated with cetuximab on day 1, 8, 15 of each 21 day cycle. Patients will be treated with pemetrexed on day 1 of each 21 day cycle for a maximum of 6 cycles. Acceptable toxicity and SD, PR or CR: treat up to 6 cycles then continue cetuximab weekly until PD or excess toxicity Performance status: ECOG 0-2 Life expectancy: At least 12 weeks Hematopoietic: * ANC \> 1,500/mm3 * Platelets \> 100,000/mm3 Hepatic: * Bilirubin less than or equal to the upper limit of normal (ULN) * Aspartate aminotransferase (AST) \< 1.5 X ULN. AST may be \< 5 X ULN for patients with liver metastases * Alkaline phosphatase \< 5 X ULN Renal: * Calculated creatinine clearance \> 45 mL/min (by Cockcroft-Gault) Cardiovascular: * No significant history of uncontrolled cardiac disease (i.e., uncontrolled hypertension, unstable angina, and congestive heart failure) Pulmonary: * Not specified
Interventions
Pemetrexed at the assigned dose, day 1 of each 21 day cycle for a maximum of 6 cycles
Cetuximab 400 mg/m2, week 1, day 1 Cetuximab 250 mg/m2, day 1, 8, 15 of each 21 day cycle
Sponsors
Study design
Eligibility
Inclusion criteria
* Histologic or cytologic diagnosis of NSCLC * Recurrent or metastatic disease that is not amenable to curative therapyMeasurable disease according to RECIST * At least one prior platinum containing regimen for either locally advanced or metastatic disease * Prior chemotherapy must be completed at least 21 days prior to being registered for protocol therapy and the subject must have recovered from the acute toxicity effects of the regimen * Ability and willingness to interrupt aspirin or other nonsteroidal anti-inflammatory agents for a 5-day period * Prior radiation therapy allowed to \< 25% of the bone marrow * Negative pregnancy test
Exclusion criteria
* No active infection that in the opinion of the investigator would compromise the subject's ability to tolerate therapy. * No serious concomitant systemic disorders that would compromise the safety of the subject or compromise the subject's ability to complete the study, at the discretion of the investigator. * No prior malignancy is allowed except for adequately treated basal cell or squamous cell skin cancer, in situ cervical cancer, or other cancer for which the subject has been disease-free for at least 2 years. * No major thoracic or abdominal surgery within 30 days prior to being registered for protocol therapy. * No current breastfeeding
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Maximum Tolerated Dose (MTD) of Pemetrexed in Combination With Cetuximab | 12 months | The primary objective of the phase I portion of this study is to define the maximum tolerated dose (MTD) of the combination of pemetrexed and cetuximab |
| Time To Progression (TTP) | 24 Months | The primary objective of the phase II portion is to estimate the time to progression of this combination, evaluated per RECIST criteria where PD= at least a 20% increase in the sum of the 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 |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Median Survival Time | 24 Months | — |
| Toxicity and Safety Profile | 12 months | — |
| Clinical Benefit Rate | 12 months | Clinical Benefit Rate (CR + PR + SD lasting more than 90 days) |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Pemetrexed + Cetuximab Pemetrexed + cetuximab for patients with recurrent non-small cell lung cancer.
Pemetrexed: Pemetrexed at the assigned dose, day 1 of each 21 day cycle for a maximum of 6 cycles
Cetuximab: Cetuximab 400 mg/m2, week 1, day 1
Cetuximab 250 mg/m2, day 1, 8, 15 of each 21 day cycle | 33 |
| Total | 33 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Withdrawal by Subject | 2 |
Baseline characteristics
| Characteristic | Pemetrexed + Cetuximab |
|---|---|
| Age, Continuous | 64 years |
| Disease Stage Disease Stage III | 2 participants |
| Disease Stage Disease Stage IV | 31 participants |
| Eastern Cooperative Oncology Group (ECOG) performance status ECOG PS 0 | 19 participants |
| Eastern Cooperative Oncology Group (ECOG) performance status ECOG PS 1 | 14 participants |
| Previous Treatment 1 Chemotherapy | 26 participants |
| Previous Treatment >2 Chemotherapy | 2 participants |
| Previous Treatment 2 Chemotherapy | 5 participants |
| Previous Treatment Previous radiotherapy | 14 participants |
| Previous Treatment Previous Targeted Therapy | 6 participants |
| Region of Enrollment United States | 33 participants |
| Sex: Female, Male Female | 13 Participants |
| Sex: Female, Male Male | 20 Participants |
| Smoking History Current Smoker | 6 participants |
| Smoking History Former Smoker | 24 participants |
| Smoking History Never a Smoker | 3 participants |
| Tumor Histology Adenocarcinoma | 18 participants |
| Tumor Histology Large cell carcinoma | 2 participants |
| Tumor Histology Non-small cell carcinoma (NOS) | 5 participants |
| Tumor Histology Squamous cell carcinoma | 8 participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 32 / 36 |
| serious Total, serious adverse events | 11 / 36 |
Outcome results
Maximum Tolerated Dose (MTD) of Pemetrexed in Combination With Cetuximab
The primary objective of the phase I portion of this study is to define the maximum tolerated dose (MTD) of the combination of pemetrexed and cetuximab
Time frame: 12 months
Population: 12 participants participated in the phase I portion of the trial.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Investigational Treatment | Maximum Tolerated Dose (MTD) of Pemetrexed in Combination With Cetuximab | 750 mg/m^2 every 21 days |
Time To Progression (TTP)
The primary objective of the phase II portion is to estimate the time to progression of this combination, evaluated per RECIST criteria where PD= at least a 20% increase in the sum of the 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
Time frame: 24 Months
Population: 27 participants had enough data to complete TTP analysis
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Investigational Treatment | Time To Progression (TTP) | 14.6 Weeks |
Clinical Benefit Rate
Clinical Benefit Rate (CR + PR + SD lasting more than 90 days)
Time frame: 12 months
Population: Data was not collected or analyzed for this secondary objective.
Median Survival Time
Time frame: 24 Months
Population: 27 participants had data sufficient to complete Median Survival Time analysis
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Investigational Treatment | Median Survival Time | 42.0 weeks |
Toxicity and Safety Profile
Time frame: 12 months
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Investigational Treatment | Toxicity and Safety Profile | ALT elevation: Phase I - Any Grade | 33.3 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | ALT elevation: Phase I - Grade 3/4 | 16.7 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | ALT elevation: Phase II - Any Grade | 0 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | ALT elevation: Phase II - Grade 3/4 | 0 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Mucositis: Phase II - Any Grade | 38 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Mucositis: Phase II - Grade 3/4 | 4.8 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Acne-like rash: Phase I - Any Grade | 58.3 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Acne-like rash: Phase I - Grade 3/4 | 16.7 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Acne-like rash: Phase II - Any Grade | 57 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Acne-like rash: Phase II - Grade 3/4 | 23.8 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Anorexia: Phase I - Grade 3/4 | 0 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Anemia: Phase I - Any Grade | 0 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Anemia: Phase I - Grade 3/4 | 0 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Anemia: Phase II - Any Grade | 14.3 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Anemia: Phase II - Grade 3/4 | 0 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Thrombocytopenia: Phase I - Any Grade | 8.3 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Thrombocytopenia: Phase I - Grade 3/4 | 0 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Thrombocytopenia: Phase II - Any Grade | 14.3 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Thrombocytopenia: Phase II - Grade 3/4 | 0 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Neutropenia: Phase I - Any Grade | 8.3 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Neutropenia: Phase I - Grade 3/4 | 0 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Neutropenia: Phase II - Any Grade | 4.8 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Neutropenia: Phase II - Grade 3/4 | 4.8 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Febrile Neutropenia: Phase I - Any Grade | 8.3 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Febrile Neutropenia: Phase I - Grade 3/4 | 8.3 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Febrile Neutropenia: Phase II - Any Grade | 0 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Febrile Neutropenia: Phase II - Grade 3/4 | 0 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Dizziness: Phase I - Any Grade | 8.3 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Dizziness: Phase I - Grade 3/4 | 8.3 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Dizziness: Phase II - Any Grade | 19 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Dizziness: Phase II - Grade 3/4 | 4.8 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Dyspnea: Phase I - Any Grade | 25 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Dyspnea: Phase I - Grade 3/4 | 8.3 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Dyspnea: Phase II - Any Grade | 33.3 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Dyspnea: Phase II - Grade 3/4 | 0 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Cough: Phase I - Any Grade | 25 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Cough: Phase I - Grade 3/4 | 0 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Cough: Phase II - Any Grade | 28.6 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Cough: Phase II - Grade 3/4 | 0 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Fatigue: Phase I - Any Grade | 33.3 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Fatigue: Phase I - Grade 3/4 | 0 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Fatigue: Phase II - Any Grade | 76 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Fatigue: Phase II - Grade 3/4 | 4.8 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Anorexia: Phase I - Any Grade | 33.3 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Anorexia: Phase II - Any Grade | 19 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Anorexia: Phase II - Grade 3/4 | 4.8 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Mucositis: Phase I - Any Grade | 41.7 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Mucositis: Phase I - Grade 3/4 | 0 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Nausea: Phase I - Any Grade | 33.3 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Nausea: Phase I - Grade 3/4 | 0 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Nausea: Phase II - Any Grade | 28.6 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Nausea: Phase II - Grade 3/4 | 0 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Diarrhea: Phase I - Any Grade | 33.3 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Diarrhea: Phase I - Grade 3/4 | 0 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Diarrhea: Phase II - Any Grade | 33.3 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Diarrhea: Phase II - Grade 3/4 | 9.5 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Constipation: Phase I - Any Grade | 16.7 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Constipation: Phase I - Grade 3/4 | 0 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Constipation: Phase II - Any Grade | 23.8 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Constipation: Phase II - Grade 3/4 | 4.8 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Fever(no neutropenia): Phase I - Any Grade | 8.3 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Fever(no neutropenia): Phase I - Grade 3/4 | 0 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Fever(no neutropenia): Phase II - Any Grade | 19 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Fever(no neutropenia): Phase II - Grade 3/4 | 4.8 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Headache: Phase I - Any Grade | 50 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Headache: Phase I - Grade 3/4 | 0 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Headache: Phase II - Any Grade | 23.8 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Headache: Phase II - Grade 3/4 | 0 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Hypomagnesmia: Phase I - Any Grade | 0 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Hypomagnesmia: Phase I - Grade 3/4 | 0 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Hypomagnesmia: Phase II - Any Grade | 19 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Hypomagnesmia: Phase II - Grade 3/4 | 4.8 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Vomiting: Phase I - Any Grade | 16.7 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Vomiting: Phase I - Grade 3/4 | 0 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Vomiting: Phase II - Any Grade | 23.8 percentage of particpants |
| Investigational Treatment | Toxicity and Safety Profile | Vomiting: Phase II - Grade 3/4 | 4.8 percentage of particpants |