Non-Small Cell Lung Cancer
Conditions
Keywords
Lung cancer, Stage III
Brief summary
This research study is looking at an alternative way of delivering radiation therapy with protons. Protons are tiny particles with a positive charge that can be controlled to travel a certain distance and stop inside the body. In theory, this allows better control of where the radiation dose is delivered as compared to photons. Information from other research studies suggests that proton radiation may help to reduce unwanted side effects from radiation and allow an increase in radiation dose that increase the odds of tumor killing. The purpose of this study is to determine the safest dose of proton radiation therapy to give in combination with standard chemotherapy in participants with Non-Small Cell Lung Cancer (NSCLC).
Detailed description
Proton radiation will be delivered daily Monday through Friday for 5 weeks. Study therapy will be give as an outpatient at the Francis H. Burr Proton Center at Massachusetts General Hospital. During the weeks that subjects receive radiation, they will also receive 2 cycles of chemotherapy. Each cycle will last 28 days. Cisplatin will be give as an IV infusion over 30-60 minutes or 1-2 hours on Days 1 and 8 of Cycles 1 and 2. Etoposide will be given as an IV infusion over 60 minutes on Days 1, 2, 3, 4, 5 of Cycles 1 and 2. After radiation and 2 cycles of chemotherapy are completed, subjects may have surgery to remove their tumor. Following surgery, subjects may receive another 2 cycles of chemotherapy (Cycles 3 and 4). Each cycles lasts 21 days. Cisplatin is given on Day 1. Etoposide is given on Days 1, 2, and 3.
Interventions
RADIATIONProton Beam Radiation
45-55 Gy total, 1.8-2.2 Gy x 25 fractions Mon-Fri for 5 weeks
DRUGCisplatin
50 mg/m2 IV on days 1, 8 of cycles 1 and 2
DRUGEtoposide
50 mg/m2 IV on days 1-5 on Cycles 1-2
Sponsors
National Cancer Institute (NCI)
Massachusetts General Hospital
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
* Histologically confirmed non-small cell lung cancer with a clinical stage of IIIA * Candidate for chemoradiation and surgical resection * Measurable disease * Life expectancy \> 6 months * Normal organ and marrow function
Exclusion criteria
* Pregnant or breast-feeding * Prior therapy for lung cancer with chemotherapy * Prior chest radiation * Compromised pulmonary function * Severe neurovascular disease * History of high cardiac risk including unstable angina * History of allergic reactions attributed to compounds of similar chemical or biologic composition to cisplatin or etoposide * Uncontrolled intercurrent illness including, but not limited to ongoing or active infection, symptomatic congestive hear failure, unstable angina pectoris, clinically significant or serious cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements * History of a different malignancy unless disease-free for at least 3 years and at low risk for recurrence. Individuals with the following cancers are eligible if diagnosed and treated within the past 3 years: cervical cancer in situ, non muscle-invasive bladder cancer, basal cell or squamous cell carcinoma of the skin * Subjects with HIV
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| MTD | 1.5 years | To establish the MTD of a proton beam-based regimen consisting of 25 fractions, together with concurrent standard cisplatin and etoposide chemotherapy followed by surgery +/- adjuvant chemotherapy for Stage III NSCLC, and to describe post-treatment surgical complications and treatment toxicity using CTCAE v4.0 |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Downstaging and Response | 1.5 years | To describe pathological downstaging and response following preoperative proton radiation and cisplatin/etoposide chemotherapy |
| Biomarkers | 1.5 years | To explore the predicitive value of biomarkers for radio- and chemosensitization in pre-treatment tumor biopsies and surgical specimens. |
| Tumor Control and Survival Rates | 5 years | To evaluate local and regional tumor control rates, progression free survival (PFS) rates, and overall survival rates and 2 and 5 years |
Countries
United States
Outcome results
None listed