Comparison of two different targeted chemotherapy pills, and chemoradiation therapy to treat Stage III Non-small Cell Lung Cancer

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"Study looking at one of two study medicines with radiation and chemotherapy, or radiation and chemotherapy to treat lung cancer"
Age:
18 to 100 years old
Gender:
Any
Healthy Volunteers:
No
Keywords:
lung, lung cancer, cancer
Type:
Radiation study, Phase 2
Investigator:
Description
This study looks at how well erlotinib hydrochloride or crizotinib (targeted chemotherapy drugs) with chemoradiation therapy works in treating patients with stage III non-small cell lung cancer. Radiation therapy uses high energy x rays to kill tumor cells. Specialized radiation therapy that delivers a high dose of radiation directly to the tumor may kill more tumor cells and cause less damage to normal tissue. Drugs used in standard chemotherapy, such as cisplatin, etoposide, paclitaxel, and carboplatin, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. It is not yet known whether giving erlotinib hydrochloride is more effective than crizotinib with chemoradiation therapy in treating patients with non-small cell lung cancer.
This study requires
Assessment of your tumor tissue for gene structure
Physical examination
Evaluation of your ability to carry out daily activities
A PET/CT scan of your body
A CT scan of your chest and upper abdomen (with contrast unless your doctor recommends otherwise)
An MRI or CT scan of your brain with contrast
To find out if your tumor has spread to lymph glands in your chest, your doctor will take a sample of the lymph gland. The sample can be taken by using a needle or by an operation done with you asleep under general anesthesia. Your doctor will discuss this with you.
Blood tests
For women able to have children, a pregnancy test

If your study doctor recommends:
An examination by a lung specialist and tests of your lung function
An EKG, a test of your heart function, and/or an echocardiogram, an ultrasound image of your heart function
An evaluation of your swallowing and diet to see if a feeding tube is needed

Study drug, Radiation, Chemotherapy or Radiation and Chemotherapy
Who can participate?
Inclusion Criteria:

- Histologically or cytologically confirmed, newly diagnosed non-squamous NSCLC

- Unresectable stage IIIA or IIIB disease; patients must be surgically staged to confirm N2 or N3 disease; patients may have invasive mediastinal staging by mediastinoscopy, mediastinotomy, endobronchial ultrasound transbronchial aspiration (EBUS-TBNA), endoscopic ultrasound (EUS), or video-assisted thoracoscopic surgery (VATS)

- Patients with any tumor (T) with node (N)2 or N3 are eligible; patients with T3, N1-N3 disease are eligible if deemed unresectable; patients with T4, any N are eligible

- Patients must have measurable disease, i.e., lesions that can be accurately measured in at least 1 dimension (longest dimension in the plane of measurement is to be recorded) with a minimum size of 10 mm by computed tomography (CT) scan (CT scan slice thickness no greater than 5 mm)

- Patients with a pleural effusion, which is a transudate, cytologically negative and non-bloody, are eligible if the radiation oncologist feels the tumor can be encompassed within a reasonable field of radiotherapy

- If a pleural effusion can be seen on the chest CT but not on chest x-ray and is too small to tap, the patient will be eligible; patients who develop a new pleural effusion after thoracotomy or other invasive thoracic procedure will be eligible

- The institution's pre-enrollment biomarker screening at a Clinical Laboratory Improvement Amendments (CLIA) certified lab documents presence of known "sensitive" mutations in epidermal growth factor receptor tyrosine kinase (EGFR TK) domain (exon 19 deletion, L858) and/or EML4-anaplastic lymphoma kinase (ALK) fusion arrangement; either the primary tumor or the metastatic lymph node tissue may be used for testing of mutations

- The institution's pre-enrollment biomarker screening at a CLIA certified lab documents absence of T790M mutation in the EGFR TK domain

- Appropriate stage for protocol entry, including no distant metastases, based upon the following minimum diagnostic workup:

- History/physical examination, including recording of pulse, blood pressure (BP), weight, and body surface area, within 45 days prior to registration

- Whole body fludeoxyglucose-positron emission tomography (FDG-PET)/CT (orbits to mid-thighs) within 30 days prior to registration; PET/CT must be negative for distant metastasis

- CT scan with contrast of the chest and upper abdomen to include liver and adrenals (unless medically contraindicated) within 30 days prior to registration

- Magnetic resonance imaging (MRI) of the brain with contrast (or CT scan with contrast, if MRI medically contraindicated) within 30 days prior to registration

- Zubrod performance status 0-1 within 14 days prior to registration

- Absolute neutrophil count (ANC) >= 1,000 cells/mm^3

- Platelets >= 100,000 cells/mm^3

- Hemoglobin >= 8.0 g/dl (Note: the use of transfusion or other intervention to achieve hemoglobin [Hgb] >= 8.0 g/dl is acceptable)

- Serum creatinine = 50 ml/min (by Cockcroft-Gault formula) within 14 days prior to registration

- Aspartate aminotransferase (AST)/alanine aminotransferase (ALT) =< 2.5 x upper limit of normal (ULN) within 14 days prior to registration

- Bilirubin within normal institutional limits within 14 days prior to registration

- Negative serum pregnancy test within 14 days prior to registration for women of childbearing potential

- Patient must provide study specific informed consent prior to study entry, including consent for mandatory screening of tissue


Exclusion Criteria:

- Prior invasive malignancy (except non-melanomatous skin cancer) unless disease free for a minimum of 730 days (2 years) (for example, carcinoma in situ of the breast, oral cavity, or cervix are all permissible)

- Prior systemic chemotherapy for the study cancer; note that prior chemotherapy for a different cancer is allowable

- Prior radiotherapy to the region of the study cancer that would result in overlap of radiation therapy fields

- Atelectasis of the entire lung

- Contralateral hilar node involvement

- Exudative, bloody, or cytologically malignant effusions

- Severe, active co-morbidity, defined as follows:

- Unstable angina and/or congestive heart failure requiring hospitalization within the last 6 months

- Transmural myocardial infarction within the last 6 months

- Acute bacterial or fungal infection requiring intravenous antibiotics at the time of registration

- Chronic obstructive pulmonary disease exacerbation or other respiratory illness requiring hospitalization or precluding study therapy at the time of registration; hepatic insufficiency resulting in clinical jaundice and/or coagulation defects

- Acquired immune deficiency syndrome (AIDS) based upon current Centers for Disease Control and Prevention (CDC) definition; note, however, that human immunodeficiency virus (HIV) testing is not required for entry into this protocol; protocol-specific requirements may also exclude immuno-compromised patients

- Pregnancy or women of childbearing potential and men who are sexually active and not willing/able to use medically acceptable forms of contraception

- Prior allergic reaction to the study drug(s) involved in this protocol
Resources
Schedule
Study duration and period
Variable
Recruitment period
From Jan. 23, 2013
Location
UC Davis Comprehensive Cancer Center
2279 45th Street
Sacramento, CA 95817
Contact
Heather Melanson
Research Topic
Conditions:
  • Stage IIIA Non-Small Cell Lung Cancer
  • Stage IIIB Non-Small Cell Lung Cancer

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