Full Text View
Tabular View
No Study Results Posted
Related Studies
Pemetrexed and/or Sunitinib as Second-Line Therapy in Treating Patients With Stage IIIB or Stage IV Non-Small Cell Lung Cancer
This study is currently recruiting participants.
Verified by National Cancer Institute (NCI), May 2009
First Received: June 14, 2008   Last Updated: May 5, 2009   History of Changes
Sponsors and Collaborators: Cancer and Leukemia Group B
National Cancer Institute (NCI)
Information provided by: National Cancer Institute (NCI)
ClinicalTrials.gov Identifier: NCT00698815
  Purpose

RATIONALE: Drugs used in chemotherapy, such as pemetrexed, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Sunitinib 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. Giving pemetrexed together with sunitinib may kill more tumor cells. It is not yet known whether pemetrexed and sunitinib are more effective when given alone or together in treating non-small cell lung cancer.

PURPOSE: This randomized phase II trial is studying pemetrexed and sunitinib to compare how well they work when given alone or together as second-line therapy in treating patients with stage IIIB or stage IV non-small cell lung cancer.


Condition Intervention Phase
Lung Cancer
Drug: pemetrexed disodium
Drug: sunitinib malate
Phase II

MedlinePlus related topics: Cancer Lung Cancer
Drug Information available for: Pemetrexed Pemetrexed disodium Sunitinib malate Sunitinib
U.S. FDA Resources
Study Type: Interventional
Study Design: Treatment, Randomized
Official Title: A Randomized Phase II Study to Assess the Efficacy of Pemetrexed or Sunitinib (NSC # 736511, IND # 74019) or Pemetrexed Plus Sunitinib in the Second-Line Treatment of Advanced Non-Small Cell Lung Cancer

Further study details as provided by National Cancer Institute (NCI):

Primary Outcome Measures:
  • 18-week progression-free survival rate [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Progression-free survival [ Designated as safety issue: No ]
  • Response rate, duration of response, rate of stable disease, and overall survival [ Designated as safety issue: No ]
  • Toxicity profile [ Designated as safety issue: Yes ]
  • Changes in tumor size at 6 weeks as an early predictor of therapeutic activity of pemetrexed disodium and/or sunitinib malate as second-line treatment for non-small cell lung cancer [ Designated as safety issue: No ]

Estimated Enrollment: 225
Study Start Date: April 2008
Estimated Primary Completion Date: August 2010 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Arm I: Active Comparator
Patients receive pemetrexed disodium IV over 10 minutes on day 1. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity. Patients with documented disease progression may then receive sunitinib malate as in arm II as third-line therapy.
Drug: pemetrexed disodium
Given IV
Arm II: Experimental
Patients receive oral sunitinib malate once daily on days 1-21. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity. Patients with documented disease progression may then receive pemetrexed disodium as in arm I as third-line therapy.
Drug: sunitinib malate
Given orally
Arm III: Experimental
Patients receive pemetrexed disodium IV over 10 minutes on day 1 and oral sunitinib malate once daily on days 1-21. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity. Patients with documented disease progression may then receive third-line therapy at the discretion of the treating physician.
Drug: pemetrexed disodium
Given IV
Drug: sunitinib malate
Given orally

Detailed Description:

OBJECTIVES:

Primary

  • To compare the 18-week progression-free survival rate in patients with stage IIIB or IV non-small cell lung cancer treated with pemetrexed disodium alone vs sunitinib malate alone vs pemetrexed disodium in combination with sunitinib malate as second-line therapy.

Secondary

  • To compare the progression-free survival of patients treated with these regimens.
  • To compare the response rate, duration of response, rate of stable disease, and overall survival of patients treated with these regimens.
  • To characterize the toxicity profiles of these regimens in these patients.
  • To determine the response rate, duration of response, rate of stable disease, and overall survival of patients who receive sunitinib malate in the third-line setting.
  • To assess the toxicity of sunitinib malate when administed in the third-line setting in these patients.
  • To test changes in tumor size at 6 weeks as an early predictor of therapeutic activity of these second-line treatment regimens.

OUTLINE: This is a multicenter study. Patients are stratified according to ECOG performance status (0 vs 1), disease stage (IIIB vs IV), and gender.

Patients are randomized to 1 of 3 treatment arms.

  • Arm I: Patients receive pemetrexed disodium IV over 10 minutes on day 1. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity. Patients with documented disease progression may then receive sunitinib malate as in arm II as third-line therapy.
  • Arm II: Patients receive oral sunitinib malate once daily on days 1-21. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity. Patients with documented disease progression may then receive pemetrexed disodium as in arm I as third-line therapy.
  • Arm III: Patients receive pemetrexed disodium IV over 10 minutes on day 1 and oral sunitinib malate once daily on days 1-21. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity. Patients with documented disease progression may then receive third-line therapy at the discretion of the treating physician. After completion of study therapy, patients are followed every 6 weeks until disease progression and then every 6 months for 2 years.
  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

DISEASE CHARACTERISTICS:

  • Histologically or cytologically confirmed non-small cell lung cancer (NSCLC)

    • Stage IIIB or IV disease
  • Must have evidence of disease progression after first-line therapy
  • Measurable or non-measurable disease

    • Measurable disease is defined as lesions that can be accurately measured in ≥ 1 dimension as ≥ 2 cm by conventional techniques or ≥ 1 cm by spiral CT scan
    • Non-measurable disease is defined as all other lesions, including small lesions (i.e., longest diameter < 20 mm by conventional techniques or < 10 mm by spiral CT scan) and truly non-measurable lesions, including any of the following:

      • Bone lesions
      • Leptomeningeal disease
      • Ascites
      • Pleural or pericardial effusion
      • Lymphangitis cutis or pulmonis
      • Abdominal mass that are not confirmed and followed by imaging techniques
      • Cystic lesions
  • No cavitary lesions
  • No pleural effusions or ascites detectable on physical exam
  • No symptomatic or untreated CNS metastases

    • Patients with CNS metastases are eligible provided the metastases were definitively treated with surgery or radiotherapy AND patient is asymptomatic and off steroids or on a stable dose of steroids for 2 weeks prior to study entry
  • Concurrent enrollment on CALGB-580702 (imaging study) required

PATIENT CHARACTERISTICS:

  • ECOG performance status 0-1
  • Granulocytes ≥ 1,500/μL
  • Platelet count ≥ 100,000/μL
  • Magnesium ≥ lower limit of normal
  • Bilirubin ≤ 1.5 times upper limit of normal (ULN)
  • AST and ALT ≤ 2.5 times ULN
  • PTT ≤ 1.5 times ULN
  • INR ≤ 1.5
  • Creatinine clearance ≥ 45 mL/min
  • Quantitative urine protein < 30 mg/dL OR ≤ 1+ on dipstick
  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective contraception during and for 6 months after completion of study therapy
  • QTc interval ≤ 500 msec
  • No ongoing cardiac dysrhythmias
  • No atrial fibrillation
  • No symptomatic congestive heart failure within the past 12 months

    • NYHA class I heart failure allowed
    • Patients with a history of NYHA class II heart failure are eligible provided at least 1 of the following criteria is met:

      • Asymptomatic on treatment
      • Previously treated with anthracycline
      • Previously treated with central thoracic radiotherapy that included the heart in the radiotherapy port
  • No myocardial infarction, severe/unstable angina, coronary/peripheral artery bypass graft or stenting, cerebrovascular accident, or transient ischemic attack within the past year
  • No hypertension that cannot be controlled by medications (i.e., blood pressure > 150/100 mm Hg despite optimal medical therapy)
  • No history of venous thrombosis, pulmonary embolism, or hypercoagulopathy syndrome
  • No history of pulmonary hemorrhage, bleeding diathesis, or evidence of hemoptysis

    • Patients with blood-tinged or blood-streaked sputum are eligible provided the hemoptysis is < 5 mL of blood per episode and < 10 mL of blood per 24-hour period, in the best estimate of the investigator
  • No interstitial pneumonitis or pulmonary fibrosis on baseline CT scan
  • No abdominal fistula, gastrointestinal perforation, intra-abdominal abscess, or serious or non-healing wound, ulcer, or bone fracture within the past 28 days
  • History of hypothyroidism allowed provided patient is currently euthyroid

PRIOR CONCURRENT THERAPY:

  • See Disease Characteristics
  • At least 28 days since prior first-line therapy

    • No more than one prior chemotherapy regimen (platinum or non-platinum based) in the first-line setting for NSCLC
  • Prior adjuvant therapy allowed provided the patient received one regimen in the advanced setting
  • At least 4 weeks since prior EGFR inhibitors or bevacizumab
  • At least 28 days since prior major surgery (6 weeks since resection of brain metastases)
  • At least 14 days since prior radiotherapy
  • More than 7 days since prior and no concurrent CYP3A4 inhibitors, including any of the following:

    • Azole antifungals (e.g., ketoconazole or itraconazole)
    • Diltiazem
    • Clarithromycin
    • Erythromycin
    • Verapamil
    • Delavirdine
    • HIV protease inhibitors (e.g., indinavir, saquinavir, ritonavir, atazanavir, or nelfinavir)
  • More than 12 days since prior and no concurrent CYP3A4 inducers, including any of the following:

    • Rifampin
    • Rifabutin
    • Carbamazepine
    • Phenobarbital
    • Phenytoin
    • St. John's wort
    • Efavirenz
    • Tipranavir
  • No prior pemetrexed disodium
  • No prior VEGFR inhibitors (e.g., semaxanib, SU6668, AZ6474, sunitinib malate, vatalanib, cediranib, AEE-788, or sorafenib)
  • No concurrent chronic daily treatment with aspirin (> 325 mg/day) or non-steroidal anti-inflammatory agents known to inhibit platelet function
  • No concurrent dipyridamole (Persantine), ticlopidine (Ticlid), clopidogrel (Plavix), and/or cilostazol (Pletal)
  • No concurrent therapeutic anticoagulation for thromboembolic disease

    • Concurrent low-dose warfarin (≤ 2 mg/day) allowed for prophylaxis of thrombosis
  • No concurrent agents with proarrhymthic potential (e.g., quinidine, procainamide, disopyramide, sotalol, probucol, bepridel, haloperidol, risperidone, indapamide, or flecainide)
  • No concurrent hormonal therapy, except steroids for adrenal failure, hormones for non-disease-related conditions (e.g., insulin for diabetes), or dexamethasone used intermittently as an antiemetic or as premedication for pemetrexed disodium
  • No other concurrent chemotherapy
  • No concurrent palliative radiotherapy
  • No concurrent G-CSF (filgrastim), GM-CSF (sargramostim), and/or pegfilgrastim
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00698815

  Show 66 Study Locations
Sponsors and Collaborators
Cancer and Leukemia Group B
Investigators
Study Chair: Mark A. Socinski, MD UNC Lineberger Comprehensive Cancer Center
Investigator: Rebecca S. Heist, MD Harvard School of Public Health
  More Information

Additional Information:
No publications provided

Responsible Party: Cancer and Leukemia Group B ( Richard L. Schilsky )
Study ID Numbers: CDR0000589102, CALGB-30704
Study First Received: June 14, 2008
Last Updated: May 5, 2009
ClinicalTrials.gov Identifier: NCT00698815     History of Changes
Health Authority: Unspecified

Keywords provided by National Cancer Institute (NCI):
stage IIIB non-small cell lung cancer
stage IV non-small cell lung cancer
recurrent non-small cell lung cancer

Study placed in the following topic categories:
Antimetabolites
Thoracic Neoplasms
Folic Acid Antagonists
Angiogenesis Inhibitors
Recurrence
Carcinoma
Pemetrexed
Folic Acid
Respiratory Tract Diseases
Lung Neoplasms
Sunitinib
Lung Diseases
Non-small Cell Lung Cancer
Carcinoma, Non-Small-Cell Lung
Neoplasms, Glandular and Epithelial

Additional relevant MeSH terms:
Thoracic Neoplasms
Antimetabolites
Antimetabolites, Antineoplastic
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Physiological Effects of Drugs
Neoplasms by Site
Respiratory Tract Diseases
Sunitinib
Lung Neoplasms
Therapeutic Uses
Growth Inhibitors
Angiogenesis Modulating Agents
Respiratory Tract Neoplasms
Neoplasms by Histologic Type
Growth Substances
Enzyme Inhibitors
Folic Acid Antagonists
Angiogenesis Inhibitors
Pharmacologic Actions
Carcinoma
Pemetrexed
Neoplasms
Lung Diseases
Carcinoma, Non-Small-Cell Lung
Neoplasms, Glandular and Epithelial

ClinicalTrials.gov processed this record on May 07, 2009