Lung Cancer Clinical Trial
Pemetrexed and/or Sunitinib as Second-Line Therapy in Treating Patients With Stage IIIB or Stage IV Non-small Cell Lung Cancer
Summary
This randomized phase II trial studies pemetrexed disodium and sunitinib malate 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. Drugs used in chemotherapy, such as pemetrexed disodium, 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 pemetrexed disodium and sunitinib malate are more effective when given alone or together in treating non-small cell lung cancer.
Full Description
PRIMARY OBJECTIVES:
I. To estimate the 18 week progression-free survival rate of pemetrexed (pemetrexed disodium) alone (Arm I), sunitinib (sunitinib malate) alone (Arm II) and pemetrexed plus sunitinib (Arm III) in the second-line setting of advanced non-small cell lung cancer (NSCLC).
SECONDARY OBJECTIVES:
I. To compare the progression-free survival of the three arms. II. To estimate the response rate, duration of response, rate of stable disease, overall survival and to characterize the toxicity profiles of the three arms.
III. To estimate the response rate, duration of response, rate of stable disease, overall survival and toxicity of sunitinib in those patients on Arm I that receive this regimen in the third line setting.
IV. To assess vascular endothelial growth factor (VEGF) haplotypes in advanced non-small cell lung cancer.
V. To test change in tumor size at 6 weeks (after 2 cycles of therapy, typically the first evaluation point in this type of study) as an early predictor of therapeutic activity in second-line treatment of non-small cell lung cancer.
OUTLINE: Patients are randomized to 1 of 3 treatment arms.
ARM I: Patients receive pemetrexed disodium intravenously (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 sunitinib malate orally (PO) once daily (QD) 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 sunitinib malate PO QD 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 treatment, patients are followed up every 6 weeks until disease progression and then every 6 months for 2 years.
Eligibility Criteria
Inclusion Criteria:
Histologic documentation: histologic or cytologic documentation of NSCLC
Stage: IIIB/IV with evidence of disease progression following first-line therapy
Tumor site: lung (non-small cell)
No cavitary lesions
Only one prior chemotherapy regimen in the first-line stage IIIB/IV setting is allowed; this could have been either a platinum- or non-platinum-based regimen
First-line therapy must be completed >= 28 days before registration
Prior adjuvant therapy is allowed provided the patient had one previous regimen in the advanced stage IIIB/IV setting
At least 28 days from prior major surgery and at least 14 days from any prior radiotherapy before registration
No prior inhibitors of VEGF receptor (VEGFR) (e.g., SU5416, SU6668, AZ6474, SU11248, PTK787, AZD2171, AEE-788, sorafenib); prior treatment with epidermal growth factor receptor (EGFR) inhibitors and bevacizumab is allowed, provided at least 4 weeks has elapsed
No prior pemetrexed
Patients must have measurable or non-measurable disease
Measurable disease
Lesions that can be accurately measured in at least one dimension (longest diameter to be recorded) as >= 2 cm with conventional techniques or as >= 1 cm with spiral computed tomography (CT) scan
Non-measurable disease
All other lesions, including small lesions (longest diameter < 20 mm with conventional techniques or < 10 mm with spiral CT scan) and truly nonmeasurable lesions
Lesions that are considered non-measurable 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
Eastern Cooperative Oncology Group (ECOG) performance status 0-1
Pregnant or nursing mothers are not eligible for this study; patients in their child bearing years must have a baseline negative pregnancy test (in the case of females); males and females must practice appropriate contraceptive measures during the period of protocol therapy and for 6 months after completion of protocol therapy; appropriate methods of birth control include abstinence, oral contraceptives, implantable hormonal contraceptives (Norplant), or double barrier method (diaphragm plus condom)
No ongoing cardiac dysrhythmias, atrial fibrillation, or history of corrected QT interval (QTc interval) > 500 msec (within 2 years prior to registration); the use of agents with proarrhythmic potential (e.g., quinidine, procainamide, disopyramide, sotalol, probucol, bepridil, haloperidol, risperidone, indapamide, flecainide) is not recommended while on protocol therapy
Patients with class I New York Heart Association (NYHA) heart failure are eligible; patients with a history of class II NYHA heart failure are eligible, provided they meet at least one of 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 symptomatic congestive heart failure within 12 months prior to entry are not eligible
No myocardial infarction, severe/unstable angina, coronary/peripheral artery bypass graft or stenting, cerebrovascular accident or transient ischemic attack 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 anticoagulation for thromboembolic disease are not eligible; Note: low doses of Coumadin (up to 2 mg daily) are permitted for prophylaxis of thrombosis
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 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
Patients with a history of hypothyroidism or hyperthyroidism are eligible, provided they are currently euthyroid
None of the following within 28 days of beginning 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 their use is discouraged
No symptomatic or untreated central nervous system (CNS) metastases; patients with CNS metastases must be asymptomatic, must have received definitive therapy (>= 6 weeks since resection or >= 2 weeks since radiotherapy) for brain metastases, and be off steroids or on a stable dose for 2 weeks prior to registration
No chronic daily treatment with aspirin (> 325 mg/day) or non-steroidal antiinflammatory agents known to inhibit platelet function; treatment with dipyridamole (Persantine), ticlopidine (Ticlid), clopidogrel (Plavix) and/or cilostazol (Pletal) is not allowed
No pleural effusions or ascites that are detectable on physical exam
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There are 112 Locations for this study
Anaheim California, 92807, United States
Arroyo Grande California, 93420, United States
Baldwin Park California, 91706, United States
Bellflower California, 90706, United States
Castro Valley California, 94546, United States
Castro Valley California, 94546, United States
Castro Valley California, 94546, United States
Emeryville California, 94608, United States
Fontana California, 92335, United States
Fremont California, 94538, United States
Harbor City California, 90710, United States
Irvine California, 92618, United States
Los Angeles California, 90027, United States
Los Angeles California, 90034, 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
Panorama City California, 91402, United States
Pismo Beach California, 93449, United States
Pleasanton California, 94588, United States
Pleasanton California, 94588, United States
Riverside California, 92505, United States
San Diego California, 92103, United States
San Diego California, 92108, United States
San Diego California, 92120, United States
San Marcos California, 92069, United States
San Pablo California, 94806, United States
Woodland Hills California, 91367, United States
Hartford Connecticut, 06102, United States
Middletown Connecticut, 06457, United States
Norwalk Connecticut, 06856, United States
Lewes Delaware, 19958, United States
Newark Delaware, 19718, United States
Washington District of Columbia, 20007, United States
Washington District of Columbia, 20010, United States
Fort Lauderdale Florida, 33308, United States
Jupiter Florida, 33458, United States
Miami Beach Florida, 33140, United States
Chicago Illinois, 60612, United States
Chicago Illinois, 60612, United States
Chicago Illinois, 60637, United States
Joliet Illinois, 60435, United States
La Grange Illinois, 60525, United States
Elkhart Indiana, 46514, United States
Elkhart Indiana, 46514, United States
Elkhart Indiana, 46515, 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, 46628, United States
Westville Indiana, 46391, United States
Bettendorf Iowa, 52722, United States
Iowa City Iowa, 52242, United States
Iowa City Iowa, 52246, United States
Augusta Maine, 04330, United States
Bangor Maine, 04401, United States
Elkton Maryland, 21921, United States
Boston Massachusetts, 02114, United States
Boston Massachusetts, 02115, United States
Boston Massachusetts, 02215, United States
Milford Massachusetts, 01757, United States
Newton Massachusetts, 02462, United States
Niles Michigan, 49120, United States
Saint Joseph Michigan, 49085, United States
Saint Joseph Michigan, 49085, United States
Minneapolis Minnesota, 55455, United States
Columbia Missouri, 65212, United States
Jefferson City Missouri, 65109, United States
Saint Louis Missouri, 63131, United States
Saint Louis Missouri, 63141, United States
Saint Louis Missouri, 63141, United States
Grand Island Nebraska, 68803, United States
Lincoln Nebraska, 68510, United States
North Platte Nebraska, 69103, 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
Las Vegas Nevada, 89102, United States
Las Vegas Nevada, 89106, United States
Exeter New Hampshire, 03833, United States
Laconia New Hampshire, 03246, United States
Camden New Jersey, 08103, United States
East Syracuse New York, 13057, United States
Glens Falls New York, 12801, United States
Manhasset New York, 11030, United States
New Hyde Park New York, 11040, United States
New Hyde Park New York, 11040, United States
Syracuse New York, 13210, United States
Syracuse New York, 13210, United States
Asheboro North Carolina, 27203, United States
Chapel Hill North Carolina, 27599, United States
Charlotte North Carolina, 28204, United States
Goldsboro North Carolina, 27534, United States
Greensboro North Carolina, 27403, United States
Kinston North Carolina, 28501, United States
Reidsville North Carolina, 27320, United States
Statesville North Carolina, 28677, United States
Washington North Carolina, 27889, United States
Wilmington North Carolina, 28401, United States
Winston-Salem North Carolina, 27157, United States
Columbus Ohio, 43210, United States
Pawtucket Rhode Island, 02860, United States
Easley South Carolina, 29640, United States
Florence South Carolina, 29506, United States
Greenville South Carolina, 29601, United States
Greenville South Carolina, 29605, United States
Greenville South Carolina, 29605, United States
Greenville South Carolina, 29605, United States
Greenville South Carolina, 29605, United States
Greenville South Carolina, 29615, United States
Greenwood South Carolina, 29646, United States
Greer South Carolina, 29650, United States
Seneca South Carolina, 29672, United States
Spartanburg South Carolina, 29307, United States
Berlin Vermont, 05602, United States
Burlington Vermont, 05405, United States
Danville Virginia, 24541, United States
Martinsville Virginia, 24115, United States
Huntington West Virginia, 25702, United States
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