Lung Cancer Clinical Trial
Cisplatin or Carboplatin, and Etoposide With or Without Sunitinib Malate in Treating Patients With Extensive-Stage Small Cell Lung Cancer
Summary
This partially randomized phase I/II trial studies the side effects and best dose of sunitinib malate and to see how well it works when given together with cisplatin or carboplatin and etoposide in treating patients with extensive-stage small cell lung cancer. Drugs used in chemotherapy, such as cisplatin, carboplatin, and etoposide, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Sunitinib malate 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. It is not yet known whether cisplatin or carboplatin and etoposide are more effective when given with or without sunitinib malate in treating small cell lung cancer.
Full Description
PRIMARY OBJECTIVES:
I. To determine the phase II dose for sunitinib (sunitinib malate) combined with cisplatin and etoposide. (Phase IB) II. To compare the progression-free survival of patients with extensive stage small cell lung cancer treated with cisplatin or carboplatin and etoposide followed by maintenance sunitinib to patients receiving the same chemotherapy followed by placebo. (Phase II)
SECONDARY OBJECTIVES:
I. To assess the single agent response rate for sunitinib given as monotherapy after chemotherapy. (Phase II) II. To assess the overall survival of patients treated with cisplatin or carboplatin and etoposide followed by sunitinib. (Phase II) III. To evaluate the toxicity and tolerability of maintenance sunitinib after cisplatin or carboplatin and etoposide. (Phase II) IV. To determine the association between vascular endothelial growth factor (VEGF) plasma levels and tumor response. (Phase II)
OUTLINE: This is a phase I, dose-escalation study of sunitinib malate followed by a randomized phase II study.
PHASE I (close to accrual 5/17/08):
COMBINATION THERAPY: Patients receive cisplatin or carboplatin intravenously (IV) on day 1, etoposide IV on days 1-3, and sunitinib malate orally (PO) once daily (QD) on days 1-14. Treatment repeats every 21 days for up to 6 courses in the absence of disease progression or unacceptable toxicity.
MAINTENANCE THERAPY: Patients receive sunitinib malate PO alone QD. Treatment continues in the absence of disease progression or unacceptable toxicity.
PHASE II:
COMBINATION THERAPY: Patients receive cisplatin or carboplatin and etoposide as in Phase I. Treatment repeats every 21 days for up to 6 courses in the absence of disease progression or unacceptable toxicity.
MAINTENANCE THERAPY: Beginning 3-8 weeks after completion of combination chemotherapy or >= 4 courses of combination therapy, patients with a responding or stable disease are randomized to 1 of 2 treatment arms. All patients must be euthyroid before starting on maintenance therapy.
ARM I: Patients receive sunitinib malate PO QD. Courses repeat every 3 weeks in the absence of disease progression or unacceptable toxicity.
ARM II: Patients receive placebo PO QD. Courses repeat every 3 weeks in the absence of disease progression or unacceptable toxicity. Patients with disease progression may cross over to Arm I.
After completion of study treatment, patients are followed up every 3 months for 1 year and then every 6 months for 2 years.
Eligibility Criteria
Inclusion Criteria:
All patients must have histologically or cytologically documented small cell lung cancer
Eligible disease stages: the extensive disease classification for this protocol includes all patients with disease sites not defined as limited stage; limited stage disease category includes patients with disease restricted to one hemithorax with regional lymph node metastases, including hilar, ipsilateral and contralateral mediastinal, and/or ipsilateral supraclavicular nodes; extensive stage patients are defined as those patients with extrathoracic metastatic, malignant pleural effusion, bilateral or contralateral supraclavicular adenopathy or contralateral hilar adenopathy
All patients must have measurable disease:
Measurable disease is defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded) as >= 20 mm with conventional techniques or as >= 10 mm with spiral computed tomography (CT) scan
Lesions that are considered non-measurable, which would make the patient not eligible, include the following:
Bone lesions
Leptomeningeal disease
Ascites
Pleural/pericardial effusion
Lymphangitis cutis/pulmonis
Abdominal masses that are not confirmed and followed by imaging techniques
Cystic lesions
No prior chemotherapy for small cell lung cancer (SCLC)
Radiation therapy must have been completed at least one week before initiation of protocol therapy
Common Toxicity Criteria (CTC) performance status:
Phase IB: 0-1
Phase II: 0-2
No "currently active" second malignancy other than non-melanoma skin cancers
No history of brain metastases, spinal cord compression, or carcinomatous meningitis
No ongoing cardiac dysrhythmias, atrial fibrillation, or QTc interval >= 500 msec; the use of agents with proarrhythmic potential (e.g., quinidine, procainamide, disopyramide, sotalol, probucol, pedridel, haloperidol, risperidone, indapamide, flecainide) is not recommended while on protocol therapy
Patients with class I New York Heart Association (NYHA) are eligible; patients with a history of class II NYHA are eligible, provided they meet the following criteria:
Patients with a history of class II heart failure who are asymptomatic on treatment
Patients with prior anthracycline exposure
Patients who have received central thoracic radiation that included the heart in the radiotherapy port
Patients with a history of class III or IV NYHA heart failure within 12 months prior to registration are not eligible
Additionally, no myocardial infarction, severe/unstable angina, coronary/peripheral artery bypass graft or stenting, cerebrovascular accident including transient ischemic attack, or pulmonary embolism within the last year
Patients with hypertension that cannot be controlled by medications (> 150/100 mmHg despite optimal medical therapy) are not eligible
Patients who require use of therapeutic doses of coumarin-derivative anticoagulants such as warfarin are excluded, although doses of up to 2 mg daily are permitted for prophylaxis of thrombosis; Note: Low molecular weight heparin is permitted provided the patient's prothrombin time (PT) international normalized ratio (INR) is =< 1.5
No evidence of hemoptysis within 4 weeks prior to starting study treatment; patients with blood-tinged or blood streaked sputum will be permitted on study if the hemoptysis amounts to less than 5 mL of blood per episode and less than 10 mL of blood per 24-hour period in the best estimate of the investigator
None of the following within 28 days of treatment: abdominal fistula, gastrointestinal perforation, intra-abdominal abscess, serious or non-healing wound, ulcer, or bone fracture
The use of the following specific inhibitors and inducers of cytochrome p450, family 3, subfamily A, polypeptide 4 (CYP3A4) is not permitted; the following inhibitors of CYP3A4 are prohibited within 7 days before and during treatment with sunitinib: azole antifungals (ketoconazole, itraconazole), diltiazem, clarithromycin, erythromycin, verapamil, delavirdine, and human immunodeficiency virus (HIV) protease inhibitors (indinavir, saquinavir, ritonavir, atazanavir, nelfinavir); the following inducers of CYP3A4 are prohibited within 12 days before beginning and during treatment with sunitinib: rifampin, rifabutin, carbamazepine, phenobarbital, phenytoin, St. John's Wort, efavirenz, tipranavir
Other inhibitors and inducers of CYP3A4 may be used if necessary, but there use is discouraged
Non-pregnant and non-nursing
Granulocytes >= 1,500/ul
Platelets >= 100,000/ul
Creatinine clearance >= 70 ml/min
Total bilirubin =< 1.5 mg/dl
Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) =< 2.5 x upper limit of normal (ULN) (patients w/ liver metastases may have AST/ALT =< 5 x ULN)
Partial thromboplastin time (PTT) =< 1.5 x ULN
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There are 100 Locations for this study
Arroyo Grande California, 93420, United States
Arroyo Grande California, 93420, United States
Castro Valley California, 94546, United States
Castro Valley California, 94546, United States
Emeryville California, 94608, United States
Fremont California, 94538, United States
Martinez California, 94553, United States
Mountain View California, 94040, United States
Oakland California, 94602, United States
Oakland California, 94609, United States
Oakland California, 94609, United States
Oakland California, 94609, United States
Oakland California, 94609, United States
San Francisco California, 94115, United States
San Pablo California, 94806, United States
Lewes Delaware, 19958, United States
Newark Delaware, 19718, United States
Washington District of Columbia, 20007, United States
Fort Lauderdale Florida, 33308, United States
Gainesville Florida, 32605, United States
Jupiter Florida, 33458, United States
Miami Beach Florida, 33140, United States
Savannah Georgia, 31404, United States
Bloomington Illinois, 61701, United States
Bloomington Illinois, 61704, United States
Canton Illinois, 61520, United States
Canton Illinois, 61520, United States
Carthage Illinois, 62321, United States
Carthage Illinois, 62321, United States
Chicago Illinois, 60637, United States
Decatur Illinois, 62526, United States
Eureka Illinois, 61530, United States
Eureka Illinois, 61530, United States
Galesburg Illinois, 61401, United States
Galesburg Illinois, 61401, United States
Havana Illinois, 62644, United States
Havana Illinois, 62644, United States
Hopedale Illinois, 61747, United States
Kewanee Illinois, 61443, United States
Kewanee Illinois, 61443, United States
La Grange Illinois, 60525, United States
Macomb Illinois, 61455, United States
Macomb Illinois, 61455, United States
Monmouth Illinois, 61462, United States
Monmouth Illinois, 61462, United States
Normal Illinois, 61761, United States
Normal Illinois, 61761, United States
Normal Illinois, 61761, United States
Ottawa Illinois, 61350, United States
Ottawa Illinois, 61350, United States
Pekin Illinois, 61554, United States
Pekin Illinois, 61554, United States
Pekin Illinois, 61554, United States
Peoria Illinois, 61614, United States
Peoria Illinois, 61615, United States
Peoria Illinois, 61636, United States
Peoria Illinois, 61637, United States
Peru Illinois, 61354, United States
Peru Illinois, 61354, United States
Princeton Illinois, 61356, United States
Princeton Illinois, 61356, United States
Rockford Illinois, 61108, United States
Spring Valley Illinois, 61362, United States
Spring Valley Illinois, 61362, United States
Elkhart Indiana, 46514, United States
Elkhart Indiana, 46514, United States
Elkhart Indiana, 46515, United States
Fort Wayne Indiana, 46845, United States
Kokomo Indiana, 46904, United States
La Porte Indiana, 46350, United States
Mishawaka Indiana, 46545, United States
Mishawaka Indiana, 46545, United States
Plymouth Indiana, 46563, United States
South Bend Indiana, 46601, United States
South Bend Indiana, 46601, United States
South Bend Indiana, 46617, United States
South Bend Indiana, 46628, United States
Westville Indiana, 46391, United States
Iowa City Iowa, 52242, United States
Bangor Maine, 04401, United States
Baltimore Maryland, 21201, United States
Elkton Maryland, 21921, United States
Salisbury Maryland, 21801, United States
Gloucester Massachusetts, 01930, United States
Niles Michigan, 49120, United States
Saint Joseph Michigan, 49085, United States
Saint Joseph Michigan, 49085, United States
Minneapolis Minnesota, 55417, United States
Minneapolis Minnesota, 55455, United States
Columbia Missouri, 65212, United States
Saint Louis Missouri, 63110, United States
Grand Island Nebraska, 68803, United States
Lincoln Nebraska, 68510, United States
North Platte Nebraska, 69101, United States
Omaha Nebraska, 68106, United States
Omaha Nebraska, 68114, United States
Omaha Nebraska, 68122, United States
Omaha Nebraska, 68124, United States
Omaha Nebraska, 68131, United States
Omaha Nebraska, 68198, United States
Concord New Hampshire, 03301, United States
Hooksett New Hampshire, 03106, United States
Laconia New Hampshire, 03246, United States
Camden New Jersey, 08103, United States
Buffalo New York, 14263, United States
East Syracuse New York, 13057, United States
Glens Falls New York, 12801, United States
New York New York, 10035, United States
New York New York, 10065, United States
Syracuse New York, 13210, United States
Durham North Carolina, 27710, United States
Goldsboro North Carolina, 27534, United States
Hendersonville North Carolina, 28791, United States
Pinehurst North Carolina, 28374, United States
Statesville North Carolina, 28677, United States
Winston-Salem North Carolina, 27157, United States
Columbus Ohio, 43210, United States
Providence Rhode Island, 02903, United States
Providence Rhode Island, 02906, United States
Beaufort South Carolina, 29902, United States
Florence South Carolina, 29506, United States
Berlin Vermont, 05602, United States
Burlington Vermont, 05405, United States
Danville Virginia, 24541, United States
Richmond Virginia, 23298, United States
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