Lung Cancer
Conditions
Keywords
recurrent small cell lung cancer
Brief summary
RATIONALE: Drugs used in chemotherapy, such as bendamustine, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. PURPOSE: This phase II trial is studying how well bendamustine works as second- or third-line therapy in treating patients with relapsed or refractory small cell lung cancer.
Detailed description
OBJECTIVES: Primary * To determine the time to progression in patients with relapsed or refractory small cell lung cancer treated with second- or third-line bendamustine. Secondary * To determine the toxicity of this drug in these patients. * To determine the response rate, progression-free survival, and overall survival of patients treated with this drug. OUTLINE: This is a multicenter study. Patients receive bendamustine IV over 1 hour on days 1 and 2. Treatment repeats every 21 days for up to 6 courses in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up every 6-8 weeks.
Interventions
Bendamustine 120 mg/m2 IV on days 1 and 2 of a 21-day treatment cycle
Sponsors
Study design
Eligibility
Inclusion criteria
DISEASE CHARACTERISTICS: * Histologically or cytologically confirmed small cell lung cancer * Relapsed or refractory disease after 1-2 prior chemotherapy regimens * Measurable disease * ECOG - Eastern Cooperative Oncology Group performance status 0-2 * ANC ≥ 1,500/mm³: ANC = Absolute neutrophil count * Platelet count ≥ 100,000/mm³ * Hemoglobin ≥ 9 g/dL * Bilirubin normal * AST/ALT ≤ 2 times upper limit of normal (ULN) (≤ 5 times ULN in patients with hepatic metastases; AST/ALT = alanine transaminase (ALT) and aspartate aminotransferase (AST) * Creatinine clearance \> 40 mL/min * Not pregnant or nursing * Negative pregnancy test * Fertile patients must use effective contraception before, during, and for ≥ 3 months after completion of study therapy * No known hypersensitivity to bendamustine * No other malignancy for which the patient has been treated within the past year except for nonmelanoma skin cancer or carcinoma in situ of the cervix * No cardiac disease, including any of the following: * Unstable angina pectoris * Life-threatening cardiac arrhythmia * Symptomatic congestive heart failure * No uncontrolled infection * No other concurrent chemotherapy, immunotherapy, or anti-tumor hormonal therapy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Time to Progression | On-study to date of progression, measured following cycle 2, 4, and 6 of a 21-day cycle for 6 cycles, (during 126 days) | Estimated probable duration from on-study date to date of disease progression, using the Kaplan-Meier method with censoring (see analysis population description for additional details). Disease progression is defined under RECIST v1.1 as \>=20% increase in sum of longest diameters of target lesions, unequivocal progression of non-target lesions, or appearance of new lesions. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Patients With Each Worst-grade Toxicity | Day 1 of each 21-day cycle for 6 cycles and at 30 days after end of treatment, at 156 days | Number of patients with worst-grade toxicity at each of five grades following NCI Common Toxicity Criteria with grade 1 = mild, grade 2 = moderate, grade 3 = severe, grade 4 = life-threatening/disabling, 5 = death. |
| Best Response | On-treatment date to date of disease progression, following cycle 2, 4, and 6 of a 21-day cycle for 6 cycles, (assessed up to 126 days) | Number of patients in each response category, per RECIST v1.1, summarized as follows for target lesion criteria (see RECIST v1.1 for additional details): complete response (CR),disappearance of target lesions; partial response (PR), \>=30% decrease in sum of longest diameter of target lesions; progressive disease (PD), \>=20% increase in sum of LD of target lesions or appearance of new lesions; stable disease (SD), insufficient change in target lesions or new lesions to qualify as either PD or SD. Patients are categorized according to the best response achieved prior to occurrence of progressive disease, where best response hierarchy is CR\>PR\>SD\>PD. |
| Progression-free Survival | On-study date to lesser of date of progression or date of death from any cause ,measured following cycle 2, 4, 6 of a 21-day cycle for 6 cycles, (assessed up to 126 days) | Estimated probable duration of life without disease progression, from on-study date to earlier of progression date or date of death from any cause, using the Kaplan-Meier method with censoring (see analysis population description for additional details). Disease progression is defined under RECIST v1.1 as \>=20% increase in sum of longest diameters of target lesions, unequivocal progression of non-target lesions, or appearance of new lesions. |
| Overall Survival | On study to date of death from any cause or last date known alive, measured every 6-8 weeks from the end of treatment, up to 31 months | Estimated probable duration of life from on-study date to date of death from any cause, using the Kaplan-Meier method with censoring (see analysis population description for additional details) |
Countries
United States
Participant flow
Recruitment details
This study opened to accrual in September 2009 and closed to accrual in February 2012
Pre-assignment details
59 patients consented, 9 were determined to be ineligible to participate
Participants by arm
| Arm | Count |
|---|---|
| Bendamustine Bendamustine 120 mg/m2 of body surface area intravenously on days 1 and 2 of a 21-day treatment cycle for a maximum of six cycles | 50 |
| Total | 50 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | clinical deterioration | 2 |
| Overall Study | complicating disease | 3 |
| Overall Study | Death | 7 |
| Overall Study | disease progression | 19 |
| Overall Study | toxicity | 7 |
| Overall Study | Withdrawal by Subject | 3 |
Baseline characteristics
| Characteristic | Bendamustine |
|---|---|
| Age, Categorical <=18 years | 0 Participants |
| Age, Categorical >=65 years | 16 Participants |
| Age, Categorical Between 18 and 65 years | 34 Participants |
| Age, Continuous | 62 years STANDARD_DEVIATION 8 |
| Region of Enrollment United States | 50 participants |
| Sex: Female, Male Female | 22 Participants |
| Sex: Female, Male Male | 28 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 50 / 50 |
| serious Total, serious adverse events | 27 / 50 |
Outcome results
Time to Progression
Estimated probable duration from on-study date to date of disease progression, using the Kaplan-Meier method with censoring (see analysis population description for additional details). Disease progression is defined under RECIST v1.1 as \>=20% increase in sum of longest diameters of target lesions, unequivocal progression of non-target lesions, or appearance of new lesions.
Time frame: On-study to date of progression, measured following cycle 2, 4, and 6 of a 21-day cycle for 6 cycles, (during 126 days)
Population: All patients are included in the analysis on intention-to treat basis. Analysis is by Kaplan-Meier method, where progression is an event, with censoring for non-progressed patients at greater of off-study date, last known alive date, or date of death not attributable to disease progression.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Bendamustine | Time to Progression | 123 days |
Best Response
Number of patients in each response category, per RECIST v1.1, summarized as follows for target lesion criteria (see RECIST v1.1 for additional details): complete response (CR),disappearance of target lesions; partial response (PR), \>=30% decrease in sum of longest diameter of target lesions; progressive disease (PD), \>=20% increase in sum of LD of target lesions or appearance of new lesions; stable disease (SD), insufficient change in target lesions or new lesions to qualify as either PD or SD. Patients are categorized according to the best response achieved prior to occurrence of progressive disease, where best response hierarchy is CR\>PR\>SD\>PD.
Time frame: On-treatment date to date of disease progression, following cycle 2, 4, and 6 of a 21-day cycle for 6 cycles, (assessed up to 126 days)
Population: All patients with best overall response data; patients are excluded if best overall response data is missing or if the patient is non-evaluable for best overall response. 8 patients were not evaluable.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Bendamustine | Best Response | Complete Response | 1 participants |
| Bendamustine | Best Response | Partial Response | 10 participants |
| Bendamustine | Best Response | Progressive Disease | 14 participants |
| Bendamustine | Best Response | Stable Disease | 17 participants |
Number of Patients With Each Worst-grade Toxicity
Number of patients with worst-grade toxicity at each of five grades following NCI Common Toxicity Criteria with grade 1 = mild, grade 2 = moderate, grade 3 = severe, grade 4 = life-threatening/disabling, 5 = death.
Time frame: Day 1 of each 21-day cycle for 6 cycles and at 30 days after end of treatment, at 156 days
Population: Total number of patients reported with any toxicity
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Bendamustine | Number of Patients With Each Worst-grade Toxicity | Number of patients with worst-grade toxicity of 1 | 1 participants |
| Bendamustine | Number of Patients With Each Worst-grade Toxicity | Number of patients with worst-grade toxicity of 2 | 14 participants |
| Bendamustine | Number of Patients With Each Worst-grade Toxicity | Number of patients with worst-grade toxicity of 3 | 21 participants |
| Bendamustine | Number of Patients With Each Worst-grade Toxicity | Number of patients with worst-grade toxicity of 4 | 5 participants |
| Bendamustine | Number of Patients With Each Worst-grade Toxicity | Number of patients with worst-grade toxicity of 5 | 9 participants |
Overall Survival
Estimated probable duration of life from on-study date to date of death from any cause, using the Kaplan-Meier method with censoring (see analysis population description for additional details)
Time frame: On study to date of death from any cause or last date known alive, measured every 6-8 weeks from the end of treatment, up to 31 months
Population: All patients are included in the analysis on intention-to-treat basis. Analysis is by Kaplan-Meier method, where death is an event, with censoring for non-expired patients at greater of off-study date or last known alive date.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Bendamustine | Overall Survival | 144 days |
Progression-free Survival
Estimated probable duration of life without disease progression, from on-study date to earlier of progression date or date of death from any cause, using the Kaplan-Meier method with censoring (see analysis population description for additional details). Disease progression is defined under RECIST v1.1 as \>=20% increase in sum of longest diameters of target lesions, unequivocal progression of non-target lesions, or appearance of new lesions.
Time frame: On-study date to lesser of date of progression or date of death from any cause ,measured following cycle 2, 4, 6 of a 21-day cycle for 6 cycles, (assessed up to 126 days)
Population: All patients are included in the analysis on intention-to-treat basis. Analysis is by Kaplan-Meier method, where either death or progression is an event, with censoring for non-progressed, non-expired patients at greater of off-study date or last known alive date.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Bendamustine | Progression-free Survival | 98 days |