No EGFR Activating Mutation, Non-small Cell Lung Cancer Metastatic or Non-small Cell Lung Cancer Recurrent
Conditions
Brief summary
In France, lung cancer is the leading cause of death induced by cancer. Therapeutic advances have been made in therapy of unresectable non-small cell lung cancer (NSCLC) with tyrosine kinase receptor inhibitors blocking the Epidermal Growth Factor Receptor (EGFR), as erlotinib. This drug usually does not induce rapid shrinking of NSCLC tumour explaining why RECIST criteria are less reliable with erlotinib than cytotoxic drugs after 8 weeks of treatment. Among patients with unresectable NSCLC, 3'-deoxy-3'-18F-fluoro-L-thymidine (18F-FLT) and 18F-2-18F-fluoro-2-deoxy-D-glucose (18F- FDG) Positron Emission Tomography (PET) has identified early responding patients and with better progression-free survival in erlotinib first line and in the second or third line. To date, none medico-economic study has been conducted to determine if this strategy will be cost-effective. The purpose of this study is to confirm that an early metabolic imaging with 18 F-FLT and 18FFDG PET could have theranostic issue by identifying at the fourteenth day of erlotinib (second line or more) the subjects that do not respond to erlotinib, i.e. 6 weeks prior to the morphological evaluation based on the new RECIST 1.1, that is typically done at week 8 of erlotinib treatment. A health economics ancillary study will be achieved. Indeed, recent therapeutic improvements, in particular targeted therapies in NSCLC, have improved quality of life and life expectancy, but have also induce an important increase of the health costs. According to studies, the mean cost of the treatments of NSCLC has been increased by a factor 3 during the 10 last years. More efficient strategies that would permit to stop early with objective endpoints, expensive therapies is a main achievement in thoracic oncology. The potential clinical impacts of this work are 1) to stop early erlotinib in non-responders and replace another treatment before a deterioration in their physical status, 2) reduce the risk of side effects and costs of unnecessary treatment and 3) to propose a customization treatment after the first line therapy.
Interventions
RADIATION18F-FLT-TEP
Patients are going to have two 18F-FLT-TEP : one during the two weeks before the beginning of erlotinib and the second one will occur during the second week after the initiation of erlotinib.
RADIATION18F-FDG-TEP
Patients are going to have two 18F-FDG-TEP : one during the two weeks before the beginning of erlotinib and the second one will occur during the second week after the initiation of erlotinib.
Sponsors
University Hospital, Tours
Army Hospital, Percy
Créteil Hospital
University Hospital, Rouen
Central Hospital, Nancy, France
University Hospital, Toulouse
University Hospital, Bordeaux
University Hospital, Angers
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* age over superior to 18 * NSCLC proved by a histological biopsy * EGFR mutation status known with no activating EGFR mutation * indication of erlotinib therapy after at least one previous therapy * patients who have signed an informed consent to participate in this study * life expectancy exceeding 12 weeks * WHO activity score between 0 and 2.
Exclusion criteria
* contraindication for the initiation of erlotinib * refusal to sign the consent * progressive inflammatory disease * infection with the HIV virus * other malignant disease * life expectancy less than 12 weeks * major adults protected by French law
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Early prediction of response to erlotinib therapy by 18F-FLT and 18F-FDG PETscans | Six months | The primary endpoint is the correlation between tumour response to erlotinib assessed by morphological imaging by RECIST 1.1 at Day 56 (considered the gold standard) and the change in the uptake of 18F-FLT and 18F-FDG assessed by PET before and at Day 7 after initiation of erlotinib derived from criteria PERCIST. the Kappa test will be used. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Economic study of the early prediction of response to erlotinib therapy by 18F-FLT and 18F-FDG PETscans | Six months | The aim of this study will be to determine if health costs could be minimized by early prediction of response to erltinib therapy. |
Countries
France
Outcome results
None listed