Lung Cancer
Conditions
Keywords
stage IIIA non-small cell lung cancer, stage IIIB non-small cell lung cancer
Brief summary
RATIONALE: Because of its success in advanced NSCLC both as a single agent and in combination with other chemotherapeutics, it is reasonable to investigate the efficacy and toxicity of docetaxel as a multimodality regimen in this patient population. Docetaxel at a dose of 20 mg/m2 appears to be a well-tolerated weekly dose when combined with either cisplatin 25 mg/m2 20-22 or carboplatin area under the curve (AUC) 2 23-25 concomitant with radiation therapy. PURPOSE: To explore the potential benefits of the radiosensitizing effects of weekly docetaxel/carboplatin/radio therapy concurrent therapy followed full dose systemic docetaxel/carboplatin consolidation therapy on overall response rate, survival, progression-free survival, safety and toxicity in patients with locally advanced NSCLC.
Detailed description
OBJECTIVES: Primary * To determine the overall survival (0S) for advanced NSCLC patients receiving concurrent chemoradiotherapy with weekly docetaxel, carboplatin and radiation therapy followed by two cycles of consolidation chemotherapy with docetaxel and carboplatin. Secondary * To determine the overall response rate in patients treated with this regimen. * To determine the time to disease progression in patients treated with this regimen. * To assess the safety and tolerability of this regimen in these patients. OUTLINE: * This is a Phase II, open label, multi-center study to determine the overall survival rate for patients treated with concurrent chemoradiotherapy with weekly docetaxel, carboplatin and radiation followed by two cycles of consolidation chemotherapy with docetaxel and carboplatin. Eligible patients will receive concurrent therapy with docetaxel (20 mg/m2) administered weekly for seven weeks as a 30-minute intra-venous (IV) infusion followed by carboplatin (AUC 2) administered weekly for seven weeks as a 30-minute IV infusion. Concurrent radiation therapy will be administered at a dose of 1.8 Gy daily 5 days/week for 25 fractions followed by a dose of 2.0 Gy daily, 5 days/week for 9 fractions (total of 34 fractions). There will be a three-week rest period following the end of the concurrent chemotherapy after which the consolidation phase will begin. During this phase of the study, patients will be treated with docetaxel (75 mg/m2) administered as a 1-hour IV infusion followed by carboplatin (AUC 6) administered as a 30-minute IV infusion. Patient will be treated every three weeks for a total of two cycles.
Interventions
DRUGCarboplatin
Carboplatin will be given weekly for seven weeks beginning on Day 1 of the study as a 30-minute intravenous infusion during concurrent therapy. Carboplatin will be given once every three weeks as a 30-minute intravenous infusion immediately following the infusion of docetaxel. Patients will receive two cycles of consolidation treatment.
DRUGDocetaxel
Docetaxel will be given weekly for seven weeks beginning on Day 1 of the study as a 30-minute intravenous infusion during concurrent therapy. Docetaxel will be given once every three weeks administered as a one-hour IV infusion. Patients will receive two cycles of consolidation treatment (1 cycle = 3 weeks).
RADIATIONradiation therapy
Radiotherapy will be administered daily X 5 day/week for 34 days beginning on Day 1 of the study. Radiotherapy will follow immediately after the infusions of docetaxel and carboplatin.
Sponsors
National Cancer Institute (NCI)
Vanderbilt-Ingram Cancer Center
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients must voluntarily sign and date an informed consent before the initiation of any study procedures * Patients must have non-metastatic, inoperable, Stage IIIA or IIIB histologically or cytologically documented NSCLC without evidence of malignant pleural effusion * Patients must not have received any prior systemic chemotherapy, thoracic radiotherapy or surgical resection for treatment of NSCLC * Patients must have at least one site of unidirectionally measurable disease * Patients must be ≥ 3 weeks from a formal exploratory thoracotomy * Patients must have a Radiation Oncology and Medical Oncology consult and approval prior to study entry * Patients must be ≥ 18 years of age * Women of childbearing potential must have a negative baseline serum pregnancy within 7 days prior to Week 1, Day 1 and must not be breast feeding. * Women of childbearing potential and men with a sexual partner of child bearing potential must use an effective method of contraception beginning prior to study entry, for the duration of the study participation and for a minimum of 3 months after the last dose of chemotherapy. * Patients must have adequate hepatic, renal, lung and bone marrow function as defined below: * Absolute neutrophil count (ANC) \> 1,500/mm3 * Hemoglobin \> 9.0 gm/dL * Creatinine \< 1.5 * Platelets \> 100,000/mm3 * Total bilirubin within normal limits (WNL) * AST or ALT and Alkaline Phosphatase must be within the range allowing for eligibility, as per chart on page 10 of the protocol. * Calculated CrCl \> 50 ml/min (via Cockroft-Gault formula). * Forced expiratory volume in 1 second (FEV 1) \> 800 ml
Exclusion criteria
* Known hypersensitivity to drugs formulated with polysorbate 80 * Peripheral neuropathy Grade ≥ 2. * Wet stage IIIB (documented malignant pleural effusion) or stage IV NSCLC * Previous chemotherapy or radiation therapy * Any concomitant malignancy, brain metastasis or uncontrolled, clinically significant medical or psychiatric disorder * Pregnant or nursing women * A greater than or equal to 10% weight loss over the past 3 months
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Overall Survival | 14.95 months (average duration, on study date to off-study date) | Months from on-study to expired/last date known alive. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time to Disease Progression | on-study date to date of progression | Time to disease progression in months |
| Overall Response Rate | on-study date to date of best response | Patient response to treatment per RECIST: Progressive disease (PD): \>=20% increase in sum of longest diameter (LD) of target lesion(s), taking as reference smallest sum LD recorded since treatment started Complete response (CR): disappearance of all target lesions Partial response (PR): \>=30% decrease in sum of LD of target lesion(s), taking as reference baseline sum LD Stable disease (SD): neither sufficient shrinkage to qualify as PR nor sufficient increase to qualify as PD |
| Number of Participants With Adverse Events by Grade | 30 days after last treatment. | Number of participants with adverse events, according to grade of event, using the NCI Common Toxicity Criteria (version 2.0) grading system to assign a grade to each event with 1 = mild, 2 = moderate, 3 = severe, 4 = life-threatening, and 5 = death related to adverse event |
Countries
United States
Participant flow
Recruitment details
Recruitment Period = 2/18/2004 through 1/23/2007
Pre-assignment details
A total of 66 people consented to take part in this study and of those, 1 was determined to be ineligible and 2 withdrew from the study prior to beginning protocol therapy.
Participants by arm
| Arm | Count |
|---|---|
| Chemo-radio Therapy Patients will receive carboplatin and docetaxel will be given weekly for seven weeks during concurrent radiotherapy. After a 3-week rest, patients will receive treatment every 3 weeks for two cycles of consolidation treatment. | 63 |
| Total | 63 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Adverse Event | 9 |
| Overall Study | Death | 3 |
| Overall Study | Disease progression | 7 |
| Overall Study | Withdrawal by Subject | 5 |
Baseline characteristics
| Characteristic | Chemo-radio Therapy |
|---|---|
| Age, Categorical <=18 years | 0 Participants |
| Age, Categorical >=65 years | 27 Participants |
| Age, Categorical Between 18 and 65 years | 36 Participants |
| Age Continuous | 63 years STANDARD_DEVIATION 1 |
| Region of Enrollment United States | 63 participants |
| Sex: Female, Male Female | 25 Participants |
| Sex: Female, Male Male | 38 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 13 / 63 |
| serious Total, serious adverse events | 37 / 63 |
Outcome results
Primary
Overall Survival
Months from on-study to expired/last date known alive.
Time frame: 14.95 months (average duration, on study date to off-study date)
Population: Patients who received at least one treatment and who were available for determination of overall survival.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Chemo-radio Therapy | Overall Survival | 11 Months |
Secondary
Number of Participants With Adverse Events by Grade
Number of participants with adverse events, according to grade of event, using the NCI Common Toxicity Criteria (version 2.0) grading system to assign a grade to each event with 1 = mild, 2 = moderate, 3 = severe, 4 = life-threatening, and 5 = death related to adverse event
Time frame: 30 days after last treatment.
Population: Patients who received treatment and who experienced an adverse event.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Chemo-radio Therapy | Number of Participants With Adverse Events by Grade | Grade 1 | 11 participants |
| Chemo-radio Therapy | Number of Participants With Adverse Events by Grade | Grade 2 | 19 participants |
| Chemo-radio Therapy | Number of Participants With Adverse Events by Grade | Grade 3 | 35 participants |
| Chemo-radio Therapy | Number of Participants With Adverse Events by Grade | Grade 4 | 12 participants |
| Chemo-radio Therapy | Number of Participants With Adverse Events by Grade | Grade 5 | 3 participants |
Secondary
Overall Response Rate
Patient response to treatment per RECIST: Progressive disease (PD): \>=20% increase in sum of longest diameter (LD) of target lesion(s), taking as reference smallest sum LD recorded since treatment started Complete response (CR): disappearance of all target lesions Partial response (PR): \>=30% decrease in sum of LD of target lesion(s), taking as reference baseline sum LD Stable disease (SD): neither sufficient shrinkage to qualify as PR nor sufficient increase to qualify as PD
Time frame: on-study date to date of best response
Population: Patients who were available for measurement of response. Six patients were not available for measurement of response and are not included in the analyzed population
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Chemo-radio Therapy | Overall Response Rate | Complete Response | 6 participants |
| Chemo-radio Therapy | Overall Response Rate | Partial Response | 33 participants |
| Chemo-radio Therapy | Overall Response Rate | Progressive Disease | 5 participants |
| Chemo-radio Therapy | Overall Response Rate | Stable Disease | 13 participants |
Secondary
Time to Disease Progression
Time to disease progression in months
Time frame: on-study date to date of progression
Population: Patients with disease progression.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Chemo-radio Therapy | Time to Disease Progression | 5 Months |