Paclitaxel, Carboplatin, and Bevacizumab With or Without Cixutumumab in Treating Patients With Stage IV or Recurrent Non-small Cell Lung Cancer
Basic Trial Information
|Phase II||Treatment||Closed||18 and over||NCI||NCI-2011-01960|
CDR0000651469, ECOG-E3508, E3508, U10CA180820, U10CA021115, NCT00955305
This randomized phase II trial studies how well paclitaxel, carboplatin, and bevacizumab work when given with or without cixutumumab in treating patients with non-small cell lung cancer that is stage IV or has come back (recurrent). Drugs used in chemotherapy, such as 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. Monoclonal antibodies, such as bevacizumab, may interfere with the ability of tumor cells to grow and spread. Other types of monoclonal antibodies, such as cixutumumab, may find tumor cells and help kill them. It is not yet known whether giving more than one drug (combination chemotherapy) together with bevacizumab is more effective when given with or without cixutumumab in treating patients with non-small cell lung cancer.
Further Study Information
I. To evaluate the progression-free survival with the combination of carboplatin, paclitaxel, and bevacizumab, and +/- IMC-A12 (cixutumumab) in patients with advanced, non-squamous, non-small cell lung cancer.
I. To evaluate overall survival and response rate of the above combination in patients with non-squamous, advanced non-small cell lung cancer.
II. To evaluate the toxicities of the above combination in patients with non-squamous advanced non-small cell lung cancer.
OUTLINE: Patients are randomized to 1 of 2 treatment arms.
ARM I: Patients receive paclitaxel intravenously (IV) over 3 hours, carboplatin IV over 30 minutes, and bevacizumab IV over 30-90 minutes on day 1.
ARM II: Patients receive paclitaxel, carboplatin, and bevacizumab as in Arm I. Patients also receive cixutumumab IV over 1 hour on days 1, 8, and 15.
In both arms, treatment repeats every 21 days for 6 courses in the absence of disease progression or unacceptable toxicity. Treatment with bevacizumab and cixutumumab may continue in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up every 3 months for 2 years and then every 6 months for 3 years.
- Patients must have histologically or cytologically confirmed non-squamous, non-small cell lung cancer (NSCLC); the following histological subtypes will be eligible: adenocarcinoma, large cell, bronchioloalveolar, and NSCLC not otherwise specified; mixed tumors will be categorized by the predominant cell type unless small cell or squamous cell elements are present, in which case the patient is ineligible; cytologic or histologic diagnosis can be established on metastatic tumor aspirates or biopsy; squamous cell carcinomas will be excluded
- Patients must have advanced NSCLC defined as either:
- Recurrent disease after prior radiation or surgery
- Stage IV (M1a or M1b) based on the TNM staging system (American Joint Committee on Cancer [AJCC] 2009)
- NOTE: In the current revision of the AJCC staging system (v7, 2009), former stage IIIB with malignant pleural effusion will now be classified as stage IV (M1a)
- Patients must have measurable disease as defined by Response Evaluation Criteria in Solid Tumors (RECIST); baseline measurements/evaluations of all sites of disease (of target and non-target disease sites) must be obtained within 4 weeks prior to randomization
- NOTE: Positron emission tomography (PET) and PET portion of PET/computed tomography (CT) are not acceptable methods of evaluation for response
- NOTE: For lesions located in a previously irradiated area to be considered measurable disease, criteria must be met
- NOTE: No prior radiation therapy to the only area of measurable disease unless there is documented progression of disease documented by physical examination, imaging tests, or pathology in this region
- No prior chemotherapy or biologic/molecular targeted therapy for advanced NSCLC; prior chemotherapy and/or biological/molecular targeted therapy as part of initial potentially curative therapy (one regimen of induction and/or adjuvant and/or concurrent chemoradiotherapy) is allowed provided it has been completed 1 year or more prior to randomization
- No prior treatment with IMC-A12 or another insulin-like growth factor 1 receptor (IGF-IR) inhibitor
- Prior radiation therapy is allowed if it has been completed 3 weeks prior to randomization and patient has recovered from any adverse events related to radiation therapy (RT)
- A head CT or magnetic resonance imaging (MRI) is required within 4 weeks prior to randomization for evaluation
- Brain metastases are allowed, provided they have been treated with surgery and/or radiotherapy, the patient is neurologically stable, and repeat brain imaging shows no progression in the brain; at least 6 weeks should have elapsed from the time of craniotomy and at least 4 weeks from radiotherapy; NOTE: Repeat MRI or CT scan should show stability or improvement in the metastatic brain lesions; patients should be neurologically stable and, if on corticosteroids, be on stable or decreasing doses of corticosteroids
- Eastern Cooperative Oncology Group (ECOG) performance status 0-1 only
- Absolute neutrophil count (ANC) >= 1500/mm³
- Platelet count >= 100,000/mm³
- Total bilirubin within institutional upper limit of normal (ULN)
- Serum creatinine =< 1.5 x ULN
- Fasting blood glucose within normal range (fasting < 120 mg/dL or below ULN)
- Alkaline phosphatase (ALP) =< 3 x ULN
- Aspartate transaminase (AST) and alanine transaminase (ALT) =< 3 x ULN
- Urine dipstick must be =< 0-1+ within 2 weeks (14 days) of randomization; if urine dipstick result is > 1+, a calculation of urine protein creatinine (UPC) ratio is required; patients must have a UPC ratio < 1.0 to participate in the study
- Patients must not be on therapeutic anticoagulation; patients international normalized ratio (INR) must be =< 1.5 or partial thromboplastin time (PTT) =< upper limits of normal within 2 weeks prior to randomization; prophylactic anticoagulation of venous access devices is allowed provided the criteria have been met; caution should be taken when treating patients with low dose heparin or low molecular weight heparin for deep vein thrombosis (DVT) prophylaxis during treatment with bevacizumab, as there may be an increased risk of bleeding
- Neuropathy, if present at baseline, must be =< Common Terminology Criteria for Adverse Events (CTCAE) grade 1
- No prior allergic reaction to compounds of chemical or biologic composition similar to those of IMC-A12; no known hypersensitivity to any component of bevacizumab
- Patients with poorly controlled diabetes mellitus are excluded; patients with a history of diabetes mellitus are allowed to participate, provided that their blood glucose is within normal range (fasting < 120 mg/dL or below ULN)
- No history of other invasive malignancies unless there is no active disease and all treatment has been completed >= 3 years prior to randomization; patients with history of in-situ malignancies and curatively resected nonmelanomatous skin cancer are eligible
- NOTE: Patients with a history of breast cancer (without evidence of disease for >= 3 years) who recently completed adjuvant hormonal therapy < 3 years from the date of registration are eligible
- Patient must have no history of thrombotic or hemorrhagic disorders; patients must have no history of bleeding diathesis or coagulopathy
- Patients must not have >= grade 2 bleeding or any bleeding requiring intervention within 4 weeks prior to randomization (please see the Cancer Therapy Evaluation Program [CTEP] active version of the CTCAE)
- Patients with a history of hypertension must be well-controlled (=< 150/90) on a stable regimen of anti-hypertensive therapy
- Patients must have no history of gross hemoptysis (defined as >= 1/2 teaspoon of bright red blood)
- Patients must not have had any of the following within 6 months prior to randomization:
- Abdominal fistula
- Gastrointestinal perforation
- Intra-abdominal abscess
- Previous myocardial infarction
- History of any central nervous system (CNS) cerebrovascular ischemia
- New York Heart Association (NYHA) > class II congestive heart failure or severe heart failure
- Unstable or symptomatic angina pectoris
- History of stroke
- Significant vascular disease
- Symptomatic peripheral vascular disease
- Patients must not have an ongoing, serious cardiac arrhythmia requiring medication at time of randomization
- Patients must not have ongoing, active infection or ongoing fever at the time of randomization or have any co-existing medical condition, psychiatric illness or limitations that would interfere with compliance of study requirements
- Patients must not have a history of hypertensive crisis or hypertensive encephalopathy
- Patients must not have had any of the following within 4 weeks prior to randomization: a serious non-healing wound, ulcer, bone fracture, or major surgical procedure
- NOTE: Patients must not have received minor surgery within 7 days prior to randomization
- Patient must not have any anticipated major surgical procedure(s) during the course of the study
- Patients must not be receiving daily treatment with aspirin (> 325 mg/day) or non-steroidal anti-inflammatory agents (NSAIDs) known to inhibit platelet function for chronic conditions; patients must not be receiving treatment with dipyridamole (Persantine), ticlopidine (Ticlid), clopidogrel (Plavix), and/or cilostazol (Pletal); if patient was receiving any of the following: aspirin (> 325 mg/day), NSAID, and/or anti-platelet drugs, patient must have discontinued its use >= 1 week prior to randomization
- Female participants must not be pregnant or breast-feeding; women of childbearing potential must have a negative pregnancy test; all females of childbearing potential must have a blood test within 1 week prior to randomization to rule out pregnancy
- Women of childbearing potential and sexually active males should use an accepted and effective method of contraception while on treatment and for 3 months thereafter
- Human immunodeficiency virus (HIV)-positive patients on combination antiretroviral therapy are not eligible
Trial Contact Information
Trial Lead Organizations/Sponsors
National Cancer Institute
Connecticut Oncology & Hematology - Torrington
Michael C. Magnifico
Genesys Hurley Cancer Institute
Philip J. Stella
Bryn Mawr Hospital
Paul B. Gilman
Cancer Center of Paoli Memorial Hospital
Paul B. Gilman
Avera Cancer Institute
Addison R Tolentino
Fox Valley Hematology and Oncology - East Grant Street
Link to the current ClinicalTrials.gov record.
NLM Identifier NCT00955305
ClinicalTrials.gov processed this data on May 19, 2015
Note: Information about this trial is from the ClinicalTrials.gov database. The versions designated for health professionals and patients contain the same text. Minor changes may be made to the ClinicalTrials.gov record to standardize the names of study sponsors, sites, and contacts. Cancer.gov only lists sites that are recruiting patients for active trials, whereas ClinicalTrials.gov lists all sites for all trials. Questions and comments regarding the presented information should be directed to ClinicalTrials.gov.