Small Cell Lung Cancer
Conditions
Keywords
Extensive Stage, Untreated
Brief summary
At this point in the treatment of extensive stage SCLC, we have reached a plateau in survival with conventional chemotherapy and newer regimens are greatly needed. It has been noted that patients with increased VEGF levels have a poorer prognosis. Anti-angiogenic agents hold significant promise in the treatment of patients with extensive stage SCLC. ZD6474, a new inhibitor of the VEGFR-2, has shown favorable action in NSCLC.
Detailed description
OUTLINE: This is a multi-center study. Arm A: Cisplatin 60mg/m2 Day 1 + Etoposide 120mg/m2 Day 1,2,3 + Placebo oral daily given continuously for the duration of the study Arm B: Cisplatin 60mg/m2 Day 1 + Etoposide 120mg/m2 Day 1,2,3 + ZD6474 100mg oral daily given continuously for the duration of the study For both arms, PE and toxicity evaluation prior to each cycle and disease assessment by imaging every 2 cycles. Patients with non-PD and acceptable toxicity will continue protocol therapy; patients with progressive disease or excessive toxicity will be taken off treatment. Cycles will be repeated every 21 days up to a total of 4 cycles. ECOG Performance Status of 0 or 1 Life Expectancy: Not specified Hematopoietic: * Platelets \> 100K/mm3 * Absolute neutrophil count (ANC) \> 1.5K/mm3 Hepatic: * Bilirubin \< 1.5 x ULN * Aspartate aminotransferase (AST) \< 2.5 x ULN or \< 5 x ULN if judged by the investigator to be related to liver metastases * Alkaline phosphatase \< 2.5 x ULN or \< 5 x ULN if judged by the investigator to be related to liver metastases Renal: * Serum creatinine \< 1.5 x ULN or Calculated creatinine clearance of \> 45 cc/min using the Cockcroft-Gault formula Cardiovascular: * No clinically significant cardiac event such as myocardial infarction; New York Heart Association (NYHA) classification of heart disease \>2 (see SPM) within 3 months prior to registration for protocol therapy * No presence of cardiac disease that, in the opinion of the Investigator, increases the risk of ventricular arrhythmia. * No history of arrhythmia (multifocal premature ventricular contractions (PVCs), bigeminy, trigeminy, ventricular tachycardia, or uncontrolled atrial fibrillation) which is symptomatic or requires treatment (CTCAE grade 3) or asymptomatic sustained ventricular tachycardia. Atrial fibrillation, controlled on medication is permitted.
Interventions
DRUGCisplatin
Cisplatin 60 mg/m2 IV day 1 every 21 days for a total of 4 cycles
DRUGEtoposide
Etoposide 120 mg/m2 IV days 1, 2, and 3 every 21 days for a total of 4 cycles
DRUGPlacebo
Matched placebo oral daily
DRUGZD6474
ZD6474 100mg oral daily to be continued for the duration of the study.
Sponsors
AstraZeneca
Hoosier Cancer Research Network
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Caregiver)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Histological or cytological proof of chemotherapy-naïve, extensive, small cell lung cancer. * Measurable disease according to RECIST and obtained by imaging within 28 days prior to being registered for protocol therapy. * Written informed consent and HIPAA authorization for release of personal health information. * Age 18 years or older at the time of consent. * Potassium ≥4.0 mmol/L and \<5.5mmol/L (supplementation is allowed). * Calcium within normal range (supplementation is allowed). * Magnesium within normal range (supplementation is allowed).
Exclusion criteria
* No prior EGFR inhibitor or antiangiogenic agent allowed. * No prior hormonal therapy. * No symptomatic brain metastasis. * No clinically significant infections as judged by the treating investigator. * No evidence of severe or uncontrolled other systemic disease or any concurrent condition which in the Investigator's opinion makes it undesirable for the subject to participate in the trial or which would jeopardize compliance with the protocol. * No previous history of QTc prolongation as a result of medication that required discontinuation of that medication. * No congenital long QT syndrome or known 1st degree relative with unexplained sudden death under 40 years of age. * No presence of left bundle branch block (LBBB.) * No QTc with Bazett's correction that is unmeasurable, or ≥480 msec on screening ECG obtained within 7 days prior to registration for protocol therapy. If a subject has QTc ≥480 msec on screening ECG, the screen ECG may be repeated twice (at least 24 hours apart). The average QTc from the three screening ECGs must be \<480 msec in order for the subject to be eligible for the study. * No concomitant (within 14 days prior to registration for and during protocol therapy) medication associated with Torsades de Pointes or cause QTc prolongation, is allowed. Medications that prolong QT, but are not strictly associated with Torsades, are allowed if medically necessary and will require increased ECG and electrolyte monitoring. * No uncontrolled hypertension (systolic blood pressure greater than 160 mm Hg or diastolic blood pressure greater than 100 mm Hg). * No currently active diarrhea that may affect the ability to absorb ZD6474. * No prior malignancy is allowed except for adequately treated basal cell or squamous cell skin cancer, in situ cervical cancer, Gleason \< grade 7 prostate cancers, or other cancer for which the subject has been disease-free for at least 5 years. * Major surgery must be completed greater than 28 days prior to registration for protocol therapy and healed surgical incision is required. * No concomitant (within 14 days prior to registration for and during protocol therapy) medications that are potent inducers (rifampicin, rifabutin, phenytoin, carbamazepine, phenobarbital and St. John's Wort) of CYP3A4 function. * Females of childbearing potential and males must be willing to use an effective method of contraception (hormonal or barrier method of birth control; abstinence) from the time consent is signed until 8 weeks after treatment discontinuation. * Females of childbearing potential must have a negative pregnancy test within 7 days prior to being registered for protocol therapy. * Females must not be breastfeeding.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Time to Disease Progression - Median Time to Progression and Log-Rank Test | 24 months | Kaplan-Meier analysis comparing arm A to arm B. Median time to progression and log-rank test. Safety lead-in participants are not included in this analysis per protocol. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants With Grade 3/4 Hematologic and Non-Hematologic Toxicities | 6 weeks (2 Cycles) | Percentage of participants who experienced grade 3/4 hematologic and non-hematologic toxicities. Participants from Arm A were compared to subjects from Arm B + Safety Lead-In. |
| Measure the Response Rate (CR + PR) in Each Arm | 24 months | Response assessments completed per Response Evaluation Criteria In Solid Tumors Criteria (RECIST Therasse et al., 2000). Complete Response (CR) is defined as: Disappearance of all target lesions. Partial Response (PR) is defined as: \>=30% decrease in the sum of the longest diameter of target lesions. |
| Measure Disease Control Rate (CR + PR+ SD) in Each Arm | 24 months | Response assessments completed per Response Evaluation Criteria In Solid Tumors Criteria (RECIST Therasse et al., 2000). Complete Response (CR) is defined as: Disappearance of all target lesions. Partial Response (PR) is defined as: \>=30% decrease in the sum of the longest diameter of target lesions. Stable Disease (SD) is defined as: neither a partial response or progressive disease ( \>=20% increase in the sum of the longest diameter of the target lesions). |
| Measure Overall Survival for Each Arm | 24 months | — |
| Assess VEGF Polymorphisms and Correlate Subject Response | 24 months | — |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Arm A: ZD6474 Matched Placebo Subjects will receive cisplatin 60 mg/m2 IV day 1 plus etoposide 120 mg/m2 IV days 1, 2, and 3 every 21 days for a total of 4 cycles plus ZD6474 matched placebo oral daily to be continued for the duration of the study. Prophylactic antiemetics will be given at the discretion of the treating investigator.
Cisplatin: Cisplatin 60 mg/m2 IV day 1 every 21 days for a total of 4 cycles
Etoposide: Etoposide 120 mg/m2 IV days 1, 2, and 3 every 21 days for a total of 4 cycles
Placebo: Matched placebo oral daily | 33 |
| Arm B: ZD6474 Subjects will receive cisplatin 60 mg/m2 IV day 1 plus etoposide 120 mg/m2 IV days 1, 2, and 3 every 21 days for a total of 4 cycles plus ZD6474 100mg oral daily to be continued for the duration of the study. Prophylactic antiemetics will be given at the discretion of the treating investigator.
Cisplatin: Cisplatin 60 mg/m2 IV day 1 every 21 days for a total of 4 cycles
Etoposide: Etoposide 120 mg/m2 IV days 1, 2, and 3 every 21 days for a total of 4 cycles
ZD6474: ZD6474 100mg oral daily to be continued for the duration of the study. | 33 |
| Safety Lead-In Subjects will receive cisplatin 60 mg/m2 IV day 1 plus etoposide 120 mg/m2 IV days 1, 2, and 3 every 21 days for a total of 4 cycles plus ZD6474 100mg oral daily to be continued for the duration of the study. Prophylactic antiemetics will be given at the discretion of the treating investigator. The safety lead-in will be conducted to determine the safety of the combination of ZD6474 and cisplation + etopiside. If this combination is found to be unsafe, no patients will be randomized in the Phase II portion of the trial. If the combination is deemed safe according to the protocol, participants from the safety lead-in cohort will not be included in the efficacy analysis.
Cisplatin: Cisplatin 60 mg/m2 IV day 1 every 21 days for a total of 4 cycles
Etoposide: Etoposide 120 mg/m2 IV days 1, 2, and 3 every 21 days for a total of 4 cycles
ZD6474: ZD6474 100mg oral daily to be continued for the duration of the study. | 7 |
| Total | 73 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 |
|---|---|---|---|---|
| Overall Study | Ineligible | 0 | 1 | 0 |
Baseline characteristics
| Characteristic | Arm A: ZD6474 Matched Placebo | Arm B: ZD6474 | Safety Lead-In | Total |
|---|---|---|---|---|
| Age, Continuous | 62.58 years STANDARD_DEVIATION 10.92 | 63.80 years STANDARD_DEVIATION 5.9 | 66.14 years STANDARD_DEVIATION 3.34 | 62.94 years STANDARD_DEVIATION 8.83 |
| Brain Metastases Absent | 23 participants | 23 participants | 2 participants | 48 participants |
| Brain Metastases Present | 10 participants | 10 participants | 5 participants | 25 participants |
| ECOG Performance Status 0 | 12 participants | 11 participants | 2 participants | 25 participants |
| ECOG Performance Status 1 | 21 participants | 22 participants | 5 participants | 48 participants |
| Ethnicity (NIH/OMB) Hispanic or Latino | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 31 Participants | 29 Participants | 7 Participants | 67 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 2 Participants | 4 Participants | 0 Participants | 6 Participants |
| Liver Metastases Absent | 17 participants | 20 participants | 6 participants | 43 participants |
| Liver Metastases Present | 16 participants | 13 participants | 1 participants | 30 participants |
| Platinum Therapy Carboplatin | 16 participants | 16 participants | 0 participants | 32 participants |
| Platinum Therapy Cisplatin | 17 participants | 17 participants | 7 participants | 41 participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 1 Participants | 0 Participants | 1 Participants |
| Race (NIH/OMB) Black or African American | 1 Participants | 1 Participants | 2 Participants | 4 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 2 Participants | 0 Participants | 2 Participants |
| Race (NIH/OMB) White | 32 Participants | 29 Participants | 5 Participants | 66 Participants |
| Region of Enrollment United States | 33 participants | 33 participants | 7 participants | 73 participants |
| Sex: Female, Male Female | 16 Participants | 14 Participants | 2 Participants | 32 Participants |
| Sex: Female, Male Male | 17 Participants | 19 Participants | 5 Participants | 41 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 32 / 33 | 39 / 41 |
| serious Total, serious adverse events | 8 / 33 | 14 / 41 |
Outcome results
Primary
Time to Disease Progression - Median Time to Progression and Log-Rank Test
Kaplan-Meier analysis comparing arm A to arm B. Median time to progression and log-rank test. Safety lead-in participants are not included in this analysis per protocol.
Time frame: 24 months
Population: Two participants from Arm A and Two Participants from Arm B were inevaluable for the time to disease progression analysis. (Reasons inevaluable include: toxicity and withdrawal of consent)
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Arm A: ZD6474 Matched Placebo | Time to Disease Progression - Median Time to Progression and Log-Rank Test | 5.68 Months |
| Arm B: ZD6474 | Time to Disease Progression - Median Time to Progression and Log-Rank Test | 5.62 Months |
Comparison: A one-sided log rank test with an overall sample size of 68 subjects (of which 34 are in arm A and 34 are in arm B) achieves 80% power at a 0.10 significance level to detect a difference of 3 months in PFS between 4 month median PFS and 7 month median PFS.p-value: 0.1Log Rank
p-value: 0.9518Log Rank
Secondary
Assess VEGF Polymorphisms and Correlate Subject Response
Time frame: 24 months
Population: This data was not collected for the safety lead-in participants.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Arm A: ZD6474 Matched Placebo | Assess VEGF Polymorphisms and Correlate Subject Response | Survival Analysis VEGF SNP rs699947 | 0.4642 probability |
| Arm A: ZD6474 Matched Placebo | Assess VEGF Polymorphisms and Correlate Subject Response | Survival Analysis VEGF SNP rs3025039 | 0.1234 probability |
| Arm A: ZD6474 Matched Placebo | Assess VEGF Polymorphisms and Correlate Subject Response | Survival Analysis VEGF SNP rs2019063 | 0.3968 probability |
| Arm A: ZD6474 Matched Placebo | Assess VEGF Polymorphisms and Correlate Subject Response | Survival Analysis VEGF SNP rs1570360 | 0.0712 probability |
| Arm A: ZD6474 Matched Placebo | Assess VEGF Polymorphisms and Correlate Subject Response | Survival Analysis VEGF SNP rs833061 | 0.4642 probability |
| Arm A: ZD6474 Matched Placebo | Assess VEGF Polymorphisms and Correlate Subject Response | Response Analysis VEGF rs699947 | 0.6034 probability |
| Arm A: ZD6474 Matched Placebo | Assess VEGF Polymorphisms and Correlate Subject Response | Response Analysis VEGF SNP rs3025039 | 0.1842 probability |
| Arm A: ZD6474 Matched Placebo | Assess VEGF Polymorphisms and Correlate Subject Response | Response Analysis VEGF SNP rs2019063 | 0.0959 probability |
| Arm A: ZD6474 Matched Placebo | Assess VEGF Polymorphisms and Correlate Subject Response | Response Analysis VEGF SNP rs1570360 | 0.4586 probability |
| Arm A: ZD6474 Matched Placebo | Assess VEGF Polymorphisms and Correlate Subject Response | Response Analysis VEGF SNP rs833061 | 0.6034 probability |
| Arm B: ZD6474 | Assess VEGF Polymorphisms and Correlate Subject Response | Response Analysis VEGF SNP rs2019063 | 0.0959 probability |
| Arm B: ZD6474 | Assess VEGF Polymorphisms and Correlate Subject Response | Survival Analysis VEGF SNP rs699947 | 0.6148 probability |
| Arm B: ZD6474 | Assess VEGF Polymorphisms and Correlate Subject Response | Response Analysis VEGF rs699947 | 0.6034 probability |
| Arm B: ZD6474 | Assess VEGF Polymorphisms and Correlate Subject Response | Survival Analysis VEGF SNP rs3025039 | 0.2050 probability |
| Arm B: ZD6474 | Assess VEGF Polymorphisms and Correlate Subject Response | Response Analysis VEGF SNP rs833061 | 0.6034 probability |
| Arm B: ZD6474 | Assess VEGF Polymorphisms and Correlate Subject Response | Survival Analysis VEGF SNP rs2019063 | 0.8486 probability |
| Arm B: ZD6474 | Assess VEGF Polymorphisms and Correlate Subject Response | Response Analysis VEGF SNP rs3025039 | 0.1842 probability |
| Arm B: ZD6474 | Assess VEGF Polymorphisms and Correlate Subject Response | Survival Analysis VEGF SNP rs1570360 | 0.4426 probability |
| Arm B: ZD6474 | Assess VEGF Polymorphisms and Correlate Subject Response | Response Analysis VEGF SNP rs1570360 | 0.4586 probability |
| Arm B: ZD6474 | Assess VEGF Polymorphisms and Correlate Subject Response | Survival Analysis VEGF SNP rs833061 | 0.6148 probability |
Comparison: Data was not collected for safety lead-in participants and these participants were not included in the analysis.
Secondary
Measure Disease Control Rate (CR + PR+ SD) in Each Arm
Response assessments completed per Response Evaluation Criteria In Solid Tumors Criteria (RECIST Therasse et al., 2000). Complete Response (CR) is defined as: Disappearance of all target lesions. Partial Response (PR) is defined as: \>=30% decrease in the sum of the longest diameter of target lesions. Stable Disease (SD) is defined as: neither a partial response or progressive disease ( \>=20% increase in the sum of the longest diameter of the target lesions).
Time frame: 24 months
Population: 12 participants were not analyzed due to missing data.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Arm A: ZD6474 Matched Placebo | Measure Disease Control Rate (CR + PR+ SD) in Each Arm | 73.08 percentage of participants |
| Arm B: ZD6474 | Measure Disease Control Rate (CR + PR+ SD) in Each Arm | 75.00 percentage of participants |
p-value: 0.872Difference in Rates
Secondary
Measure Overall Survival for Each Arm
Time frame: 24 months
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Arm A: ZD6474 Matched Placebo | Measure Overall Survival for Each Arm | 9.23 Months |
| Arm B: ZD6474 | Measure Overall Survival for Each Arm | 13.24 Months |
p-value: 0.4577Log Rank
Secondary
Measure the Response Rate (CR + PR) in Each Arm
Response assessments completed per Response Evaluation Criteria In Solid Tumors Criteria (RECIST Therasse et al., 2000). Complete Response (CR) is defined as: Disappearance of all target lesions. Partial Response (PR) is defined as: \>=30% decrease in the sum of the longest diameter of target lesions.
Time frame: 24 months
Population: 12 participants are excluded due to missing data.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Arm A: ZD6474 Matched Placebo | Measure the Response Rate (CR + PR) in Each Arm | 65.38 percentage of participants |
| Arm B: ZD6474 | Measure the Response Rate (CR + PR) in Each Arm | 50.00 percentage of participants |
p-value: 0.2533Difference in Rates
Secondary
Percentage of Participants With Grade 3/4 Hematologic and Non-Hematologic Toxicities
Percentage of participants who experienced grade 3/4 hematologic and non-hematologic toxicities. Participants from Arm A were compared to subjects from Arm B + Safety Lead-In.
Time frame: 6 weeks (2 Cycles)
Population: The participants from the safety run-in cohort were combined with the participants from ARM B for analysis of safety.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Arm A: ZD6474 Matched Placebo | Percentage of Participants With Grade 3/4 Hematologic and Non-Hematologic Toxicities | Grade 3/4 Non-Hematologic Toxicity | 2.71 percentage of participants |
| Arm A: ZD6474 Matched Placebo | Percentage of Participants With Grade 3/4 Hematologic and Non-Hematologic Toxicities | Grade 3/4 Hematologic Toxicity | 11.00 percentage of participants |
| Arm B: ZD6474 | Percentage of Participants With Grade 3/4 Hematologic and Non-Hematologic Toxicities | Grade 3/4 Hematologic Toxicity | 13.75 percentage of participants |
| Arm B: ZD6474 | Percentage of Participants With Grade 3/4 Hematologic and Non-Hematologic Toxicities | Grade 3/4 Non-Hematologic Toxicity | 4.30 percentage of participants |