Lung Cancer
Conditions
Keywords
squamous cell lung cancer, adenocarcinoma of the lung, bronchoalveolar cell lung cancer, large cell lung cancer, stage IIIA non-small cell lung cancer, stage IIIB non-small cell lung cancer, adenosquamous cell lung cancer
Brief summary
RATIONALE: Drugs used in chemotherapy, such as carboplatin and paclitaxel, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Selenomethionine may slow the growth of tumor cells. Radiation therapy uses high-energy x-rays to kill tumor cells. Giving combination chemotherapy together with selenomethionine and radiation therapy may kill more tumor cells. PURPOSE: This phase II trial is studying the side effects and how well selenomethionine works when given together with carboplatin, paclitaxel, and radiation therapy in treating patients with stage III non-small cell lung cancer that cannot be removed by surgery.
Detailed description
OBJECTIVES: Primary * Determine the safety and tolerability of selenomethionine in combination with chemotherapy and radiotherapy in patients with unresectable stage IIIA or IIIB non-small cell lung cancer. * Determine if the incidence of excessive adverse events, in the form of esophagitis, pneumonitis, and myelosuppression, can be reduced with this regimen. Secondary * Estimate response rate, failure-free survival, and overall survival of these patients. * Correlate selenium levels with degree of observed adverse events. OUTLINE: This is a multicenter study. Patients receive oral selenomethionine twice daily for 1 week and then once daily for 6 weeks. Patients also receive paclitaxel IV over 1 hour once weekly and carboplatin IV over 30 minutes once weekly for 6 weeks and undergo radiotherapy 5 days a week for 6 weeks. Treatment continues in the absence of disease progression or unacceptable toxicity. Blood samples are collected at baseline and weekly during treatment and analyzed by absorption spectrophotometry for selenium measurement of drug concentration After the completion of study treatment, patients are followed periodically.
Interventions
Oral Twice daily
Weekly IV
Weekly IV
Correlative Study
Undergoing radiation Therapy
Sponsors
Study design
Eligibility
Inclusion criteria
DISEASE CHARACTERISTICS: * Histologically or cytologically confirmed non-small cell lung cancer (NSCLC), including any of the following histologic subtypes: * Squamous cell carcinoma * Adenocarcinoma (including bronchoalveolar cell carcinoma) * Large cell anaplastic carcinoma (including giant and clear cell carcinoma) * Stage IIIA disease OR selected stage IIIB disease * T1-2, N2 disease OR T3, N2 or T4, N0-N2 disease (if based on tumor closeness to the carina, invasion of the mediastinum, or invasion of the chest wall) * Contralateral mediastinal disease (N3) allowed if all gross disease can be encompassed in the radiation boost field * Tumors adjacent to a vertebral body allowed unless there is demonstrable bone invasion * All gross disease must be able to be encompassed in the radiation boost field * No direct invasion of a vertebrae body * Unresectable or inoperable disease * Measurable disease * Suitable for radiotherapy, as deemed by the radiation oncologist * No scalene, supraclavicular, or contralateral hilar node involvement * Pleural effusion allowed provided it is transudate, cytologically negative, and non-bloody, and, according to the radiation oncologist, the tumor can be encompassed within a reasonable radiation field * Pleural effusion seen on chest CT scan, but not on chest x-ray, that is too small to tap is allowed * No exudative, bloody, or cytologically malignant effusions * No known brain metastases PATIENT CHARACTERISTICS: * ECOG performance status 0-1 * ANC ≥ 1,500/mm³ * Platelet count ≥ 75,000/mm³ * Total bilirubin ≤ 1.5 mg/dL * Creatinine normal * Alkaline phosphatase AND AST or ALT meeting 1 of the following criteria: * Alkaline phosphatase normal AND AST or ALT ≤ 5 times upper limit of normal (ULN) * Alkaline phosphatase ≤ 2.5 times ULN AND AST or ALT ≤ 1.5 times ULN * Alkaline phosphatase ≤ 5 times ULN AND AST or ALT normal * Able to swallow oral medications * No peripheral neuropathy \> grade 1 * No history of allergic reactions attributed to compounds of similar chemical or biologic composition to selenomethionine or agents formulated with Cremophor EL * No concurrent uncontrolled illness including, but not limited to, any of the following: * Ongoing or active infection * Symptomatic congestive heart failure * Unstable angina pectoris * Clinically significant cardiac arrhythmia * Psychiatric illness or social situations that would limit compliance with study requirements * No currently active second malignancy other than non-melanoma skin cancer * Patients are considered not to have an active malignancy if they have completed therapy and are considered by their physician to be at less than 30% risk of relapse * Not pregnant * Negative pregnancy test * Fertile patients must use effective contraception PRIOR CONCURRENT THERAPY: * At least 2 weeks since prior formal exploratory thoracotomy (N2 node identified making patient ineligible for surgery) * No prior chemotherapy or radiotherapy for NSCLC * No prior taxanes or platinum drugs * No other concurrent investigational agents or anticancer therapy * No concurrent combination antiretroviral therapy for HIV-positive patients * No other concurrent chemotherapy or hormonal therapy, except for the following: * Steroids administered for adrenal failure or septic shock * Hormones administered for non-disease-related conditions (e.g., insulin for diabetes) * Glucocorticosteroids administered as antiemetics
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Incidence of Grade 3-4 Esophagitis | During study treatment, up to 6 weeks |
| Incidence of Grade 3-4 Pneumonitis | During study treatment, up to 6 weeks |
| Incidence of Grade 3-4 Myelosuppression | During study treatment, up to 6 weeks |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Response Rate | 1 month post-treatment, then q 3 months x 4 | Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0) for target lesions and assessed by MRI: Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), \>=30% decrease in the sum of the longest diameter of target lesions; Overall Response (OR) = CR + PR. |
| Selenium Level by Incidence of SAE | Pre-treatment and every week for 6 weeks prior to chemotherapy. | Median Selenium level by Incidence of SAE. Mann-Whitney-Wilcoxon test was used to test the correlation between selenium levels and serious adverse events. |
| Failure-free Survival | Post-treatment follow-up every 3 months x4, then per institute standard of practice every 6 months for 2 years, then yearly therafter. | — |
| Overall Survival | Post-treatment follow-up every 3 months x4, then per institute standard of practice every 6 months for 2 years, then yearly therafter | — |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| CPSR Concurrent Carboplatin, Paclitaxel and Selenomethionine in Combination with Radiation | 16 |
| Total | 16 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Adverse Event | 2 |
Baseline characteristics
| Characteristic | CPSR |
|---|---|
| Age, Continuous | 63.25 years STANDARD_DEVIATION 9.22 |
| Sex: Female, Male Female | 11 Participants |
| Sex: Female, Male Male | 5 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 16 / 16 |
| serious Total, serious adverse events | 4 / 16 |
Outcome results
Incidence of Grade 3-4 Esophagitis
Time frame: During study treatment, up to 6 weeks
Population: Treated with Study Therapy
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| CPSR | Incidence of Grade 3-4 Esophagitis | 18.75 percentage of participants |
Incidence of Grade 3-4 Myelosuppression
Time frame: During study treatment, up to 6 weeks
Population: Patients Treated with Study Therapy
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| CPSR | Incidence of Grade 3-4 Myelosuppression | 12.50 percentage of participants |
Incidence of Grade 3-4 Pneumonitis
Time frame: During study treatment, up to 6 weeks
Population: Patients treated with study therapy
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| CPSR | Incidence of Grade 3-4 Pneumonitis | 0 percentage of participants |
Failure-free Survival
Time frame: Post-treatment follow-up every 3 months x4, then per institute standard of practice every 6 months for 2 years, then yearly therafter.
Population: Patients treated with study therapy
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| CPSR | Failure-free Survival | 9.0 months |
Overall Survival
Time frame: Post-treatment follow-up every 3 months x4, then per institute standard of practice every 6 months for 2 years, then yearly therafter
Population: Patients treated with study therapy
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| CPSR | Overall Survival | 14.5 months |
Response Rate
Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0) for target lesions and assessed by MRI: Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), \>=30% decrease in the sum of the longest diameter of target lesions; Overall Response (OR) = CR + PR.
Time frame: 1 month post-treatment, then q 3 months x 4
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| CPSR | Response Rate | 50 percentage of patients |
Selenium Level by Incidence of SAE
Median Selenium level by Incidence of SAE. Mann-Whitney-Wilcoxon test was used to test the correlation between selenium levels and serious adverse events.
Time frame: Pre-treatment and every week for 6 weeks prior to chemotherapy.
Population: All treated and eligible patients
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| CPSR | Selenium Level by Incidence of SAE | No SAE | 1435.0 ng/mL |
| CPSR | Selenium Level by Incidence of SAE | SAE | 1803.6 ng/mL |