Lung Cancer
Conditions
Keywords
recurrent non-small cell lung cancer, stage IIIB non-small cell lung cancer, stage IV non-small cell lung cancer, adenocarcinoma of the lung, bronchoalveolar cell lung cancer, large cell lung cancer
Brief summary
RATIONALE: Sorafenib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth and by blocking blood flow to the tumor. PURPOSE: This phase II trial is studying how well sorafenib works in treating non-smokers or former light smokers with relapsed or refractory stage IIIB or stage IV non-small cell lung cancer.
Detailed description
OBJECTIVES: Primary * To determine the efficacy of sorafenib tosylate, in terms of 6-month progression-free survival rate, in non-smokers or former light smokers with relapsed or refractory stage IIIB or IV non-small cell lung cancer. Secondary * To determine the 1-year survival rate in patients treated with this drug. * To assess the frequency and severity of adverse events associated with this drug in these patients. * To investigate the mutational status of EGFR (epidermal growth factor receptor), ALK (anaplastic lymphoma kinase), ROS1, and K-Ras(Kirsten rat sarcoma viral oncogene homolog)in archived tumor samples from these patients. OUTLINE: Patients receive oral sorafenib tosylate twice daily on days 1-28. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. Archived tumor tissue samples are analyzed for mutations of EGFR, ALK, ROS1, and K-Ras by PCR (polymerase chain reaction) and DNA (deoxyribonucleic acid) sequencing. After completion of study treatment, patients are followed every 3 months.
Interventions
administered orally at 400 mg taken twice daily , continuously on a 28 day cycle as an outpatient.
Sponsors
Study design
Eligibility
Inclusion criteria
DISEASE CHARACTERISTICS: * Histologically confirmed non-small cell lung cancer * Stage IIIB or IV disease * Recurrent disease after prior surgery, chemotherapy, or radiotherapy * No squamous cell histology or mixed tumor with \> 50% squamous cells * Non-smoker (smoked ≤ 100 cigarettes in lifetime) OR former light smoker (smoked \> 100 cigarettes but ≤ 10 pack years AND quit smoking ≥ 1 year ago) * No known brain metastasis * Patients with neurological symptoms must undergo a CT scan or MRI of the brain to exclude brain metastasis PATIENT CHARACTERISTICS: * ECOG(Eastern Cooperative Oncology Group)performance status 0-2 * ANC (Absolute Neutrophil Count)≥ 1,500/mm³ * Platelet count ≥ 100,000/mm³ * ALT (Alanine Aminotransferase Test) and AST (Aspartate Aminotransferase Test) ≤ 2.5 times upper limit of normal (ULN) * Alkaline phosphatase ≤ 2.5 times ULN * Bilirubin ≤ 1.5 mg/dL * Creatinine clearance ≥ 50 mL/min * INR (International Normalized Ratio) \< 1.5 OR PT/PTT (Prothrombin time/partial thromboplastin time)normal * Not pregnant or nursing * Negative pregnancy test * Fertile patients must use effective barrier contraception prior to, during, and for ≥ 3 months after completion of study treatment * No cardiac disease, including any of the following: * New York Heart Association class III-IV congestive heart failure * Unstable angina (anginal symptoms at rest) * New-onset angina within the past 3 months * Myocardial infarction within the past 6 months * No cardiac ventricular arrhythmias requiring anti-arrhythmic therapy * No uncontrolled hypertension (i.e., systolic blood pressure \[BP\] \> 150 mm Hg or diastolic BP \> 90 mm Hg) despite optimal medical management * No thrombolic or embolic events (e.g., cerebrovascular accident, including transient ischemic attacks) within the past 6 months * No pulmonary hemorrhage or bleeding event ≥ CTCAE (Common Terminology Criteria for Adverse Events)grade 2 within the past 4 weeks * No other hemorrhage or bleeding event ≥ CTCAE grade 3 within the past 4 weeks * No active clinically serious infection \> CTCAE grade 2 * No serious non-healing wound, ulcer, or bone fracture * No evidence or history of bleeding diathesis or coagulopathy * No known HIV infection or chronic hepatitis B or C * No other malignancy except for any of the following: * Adequately treated basal cell or squamous cell skin cancer * In situ cervical cancer * Other cancer from which the patient has been disease-free for ≥ 5 years with a low probability of recurrence * No condition that impairs the patient's ability to swallow whole pills * No malabsorption problems * No known or suspected allergy to sorafenib tosylate or any agent given in the course of this study * No significant traumatic injury within the past 4 weeks PRIOR CONCURRENT THERAPY: * See Disease Characteristics * No more than one prior systemic chemotherapy treatment for metastatic disease * Prior treatment with EGFR inhibitors is not considered chemotherapy * More than 4 weeks since prior major surgery or open biopsy * No prior sorafenib tosylate * No concurrent St. John's wort or rifampin * Concurrent anticoagulation with warfarin or heparin allowed
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Progression-free Survival at 6 Months | 6 months | Progression is defined using Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0), as a 20% increase in the sum of the longest diameter of target lesions, or a measurable increase in a non-target lesion, or the appearance of new lesions, or similar definition as accurate and appropriate |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Overall Survival Rate | Up to 2 years | Determine the one year survival rate in Non/Light smokers with advanced and previouslytreated NSCLC |
| Incidence of Adverse Events Sssessed by Common Terminology Criteria for Adverse Events (CTCAE) | Up to 2 years | Assess the frequency and severity of adverse events associated with Sorafenib in this patient population Non/Light smokers with advanced and previously treated NSCLC. |
| Mutational Status for EGFR or Kras | up to 2 years | — |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Treatment: Sorafenib Sorafenib will be administered at a dose of 400 mg taken twice daily, continuously on a 28 day cycle.
sorafenib: administered orally at 400 mg taken twice daily , continuously on a 28 day cycle as an outpatient. | 11 |
| Total | 11 |
Baseline characteristics
| Characteristic | Treatment: Sorafenib |
|---|---|
| Age, Continuous | 70 years |
| Sex: Female, Male Female | 8 Participants |
| Sex: Female, Male Male | 3 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 6 / 11 |
| serious Total, serious adverse events | 1 / 11 |
Outcome results
Progression-free Survival at 6 Months
Progression is defined using Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0), as a 20% increase in the sum of the longest diameter of target lesions, or a measurable increase in a non-target lesion, or the appearance of new lesions, or similar definition as accurate and appropriate
Time frame: 6 months
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Treatment: Sorafenib | Progression-free Survival at 6 Months | 11 participants |
Incidence of Adverse Events Sssessed by Common Terminology Criteria for Adverse Events (CTCAE)
Assess the frequency and severity of adverse events associated with Sorafenib in this patient population Non/Light smokers with advanced and previously treated NSCLC.
Time frame: Up to 2 years
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Treatment: Sorafenib | Incidence of Adverse Events Sssessed by Common Terminology Criteria for Adverse Events (CTCAE) | Fatigue | 9 percentage of participants |
| Treatment: Sorafenib | Incidence of Adverse Events Sssessed by Common Terminology Criteria for Adverse Events (CTCAE) | Rash | 55 percentage of participants |
Mutational Status for EGFR or Kras
Time frame: up to 2 years
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Treatment: Sorafenib | Mutational Status for EGFR or Kras | 7 participants |
Overall Survival Rate
Determine the one year survival rate in Non/Light smokers with advanced and previouslytreated NSCLC
Time frame: Up to 2 years
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Treatment: Sorafenib | Overall Survival Rate | 8.8 months |