Erlotinib With or Without Bevacizumab in Treating Patients With Stage IV Non-Small Cell Lung Cancer With EGFR Mutations

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Basic Trial Information

PhaseTypeStatusAgeSponsorProtocol IDs
Phase IIBiomarker/Laboratory analysis, TreatmentActive18 and overOtherRC1126
NCI-2012-00053, NCT01532089

Trial Description


This randomized phase II trial studies how well giving erlotinib (Tarceva) with or without bevacizumab (Avastin) works in treating patients with stage IV non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) mutations. Erlotinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Monoclonal antibodies, such as bevacizumab, can block tumor growth in different ways. Bevacizumab blocks the ability of tumors to grow new blood vessels and spread. It is not yet known whether erlotinib is more effective when given alone or with bevacizumab.

Further Study Information

PRIMARY OBJECTIVES: I. To determine the progression-free survival of erlotinib (erlotinib) and bevacizumab versus that of erlotinib alone for the purpose of deciding if the combination arm is worth pursuing in a phase III trial. SECONDARY OBJECTIVES: I. To investigate the overall survival of erlotinib and bevacizumab versus erlotinib alone. II. To investigate the response rate of erlotinib and bevacizumab versus erlotinib alone. III. To investigate the progression-free survival in patients with exon deletion 19 or exon 21 L858R EGFR point mutations. IV. To investigate the toxicity of erlotinib and bevacizumab versus erlotinib alone using Common Terminology Criteria for Adverse Events (CTCAE) version 4.0. TERTIARY OBJECTIVES: I. To correlate EGFR mutations detected in plasma deoxyribonucleic acid (DNA) with those detected in tumor DNA. II. To estimate the prevalence of EGFR T790M resistance mutations from pretreatment tumor biopsies using more sensitive mutation detection methods. III. To investigate progression free survival of EGFR mutant NSCLC patients with and without concurrent EGFR T790M detected from pre-treatment tumor specimen using allele specific quantitative polymerase chain reaction (PCR). IV. To prospectively evaluate the predictive value of plasma vascular endothelial growth factor A (VEGF-A) levels on progression free survival in patients treated with erlotinib alone or in combination with bevacizumab. OUTLINE: Patients are randomized to 1 of 2 treatment arms. ARM A: Patients receive erlotinib orally (PO) once daily (QD) on days 1-21. ARM B: Patients receive erlotinib as in Arm A and bevacizumab intravenously (IV) over 30-90 minutes on day 1. In both arms, courses repeat every 21 days in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up periodically for up to 5 years.

Eligibility Criteria

Inclusion Criteria:

  • Histologic documentation of primary lung carcinoma, non-squamous histology with activating epidermal growth factor receptor (defined as deletion 19 or exon 21 L858R mutation) *Note: EGFR mutation testing must be performed at a Clinical Laboratory Improvement Amendments (CLIA) certified lab; either institutional or through a commercial laboratory (e.g. Genzyme, Response Genetics, etc); the laboratory report from the commercial laboratories report the specific mutations detected, and the method of detecting the exon 19 and exon 21 L858R point mutations must be available
  • Stage IV disease according to the 7th Edition of the American Joint Committee on Cancer staging system -Measureable disease- Life expectancy of >= 12 months
  • Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) 0 or 1
  • Absolute neutrophil count (ANC) >= 1, 500/mm^3
  • Platelet count >= 100,000/mm^3
  • Hemoglobin >= 9.0 g/dL
  • Total bilirubin =< 1.5 x upper limit of normal (ULN)
  • Serum glutamic oxaloacetic transaminase (SGOT) (aspartate aminotransferase [AST]) and serum glutamic pyruvic transaminase (SGPT) (alanine aminotransferase [ALT]) =< 2.5 x ULN in patients without liver or bone metastases; < 5 x ULN in patients with liver or bone metastases
  • Cockcroft-Gault calculated creatinine clearance of >= 45 ml/min or creatinine =< 1.5 x ULN
  • Prothrombin time (PT) =< 1.5 x ULN
  • Partial thromboplastin time (PTT) =< ULN
  • Urine dipstick proteinuria < 2+ * Note: Patients discovered to have >= 2 + proteinuria on dipstick urinalysis at baseline should undergo a 24-hour urine collection and must demonstrate < 1 g of protein in 24 hours
  • Negative pregnancy test done =< 7 days prior to randomization, for women of childbearing potential only
  • Provide informed written consent
  • Willing to return to Alberta Cooperative Conservation Research Unit (ACCRU) enrolling institution for follow-up
  • Willing to provide tissue and blood samples for correlative research purposes

Exclusion Criteria:

  • Mixed, non-small cell and small cell tumors or mixed adenosquamous carcinomas with a predominant squamous component
  • Prior chemotherapy or treatment for metastatic non-small cell lung cancer Any of the following because this study involves an investigational agent whose genotoxic, mutagenic and teratogenic effects on the developing fetus and newborn are unknown * Pregnant women * Nursing women * Men or women of childbearing potential who are unwilling to employ adequate contraception Co-morbid systemic illnesses or other severe concurrent disease which, in the judgment of the investigator, would make the patient inappropriate for entry into this study or interfere significantly with the proper assessment of safety and toxicity of the prescribed regimens
  • Immunocompromised patients (other than that related to the use of corticosteroids) including patients known to be human immunodeficiency virus (HIV) positive, per MD discretion
  • Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
  • Receiving any other investigational agent which would be considered as a treatment for the primary neoplasm
  • Other active malignancy =< 3 years prior to randomization; EXCEPTIONS: Non melanotic skin cancer or carcinoma-in-situ of the cervix * Note: If there is a history of prior malignancy, they must not be receiving other specific treatment (i.e. hormonal therapy) for their cancer
  • History of myocardial infarction or other evidence of arterial thrombotic disease (angina) * Note: Allowed only if patient has no evidence of active disease for at least 6 months prior to randomization
  • History of cerebral vascular accident (CVA) or transient ischemic attack (TIA) =< 6 months prior to randomization
  • Ongoing or active infection, symptomatic congestive heart failure (New York Heart Association >= grade 2), cardiac arrhythmia, psychiatric illness/social situations, or any other medical condition that would limit compliance with study requirements
  • History of bleeding diathesis or coagulopathy
  • Inadequately controlled hypertension (systolic blood pressure of > 150 mmHg or diastolic pressure > 100 mmHg on anti-hypertensive medications) * Note: History of hypertensive crisis or hypertensive encephalopathy not allowed
  • Current or recent (=< 10 days prior to randomization use of aspirin (> 325 mg/day), clopidogrel (> 75 mg/day), or current or recent (=< 10 days prior to randomization use of full- dose (i.e. therapeutic dose) oral or parenteral anticoagulants or thrombolytic agent for therapeutic purposes * Note: Prophylactic use of anticoagulants is allowed
  • Serious non-healing wound, ulcer, bone fracture, or have undergone a major surgical procedure, open biopsy, or significant traumatic injury =< 28 days or core biopsy =< 7 days prior to randomization
  • History of abdominal fistula, gastrointestinal perforation, or intrabdominal abscess =< 6 months prior to randomization
  • Known hypersensitivity to Chinese hamster ovary cell products or other recombinant human antibodies
  • History of hemoptysis >= grade 2 (defined as bright red blood of at least 2.5 mL) =< 3 months prior to randomization
  • Known central nervous system (CNS) disease, except for treated brain metastasis * Note: Treated brain metastases are defined as having no evidence of progression or hemorrhage after treatment and no ongoing requirement for dexamethasone, for at least 7 days as ascertained by clinical examination and brain imaging (magnetic resonance imaging [MRI] or computed tomography [CT]) during the screening period; anticonvulsants (stable dose) are allowed; treatment for brain metastases may include whole brain radiotherapy (WBRT), radiosurgery (RS; Gamma Knife, linear accelerator [LINAC], or equivalent) or a combination as deemed appropriate by the treating physician; patients with CNS metastases treated by neurosurgical resection or brain biopsy performed =< 3 months prior to randomization will be excluded
  • Significant vascular disease (e.g. aortic aneurysm surgical repair or recent peripheral arterial thrombosis) =< 6 months prior to randomization Radiotherapy to any site for any reason =< 28 days prior to randomization *Note: Palliative radiotherapy to bone lesions and WBRT > 14 days prior to randomization is allowed
  • Receiving any medications or substances that are strong or moderate inhibitors of cytochrome P450 3A4 (CYP3A4) are prohibited =< 7 days prior to registration
  • Receiving any medications or substances that are inducers of CYP3A4 use of inducers are prohibited =< 7 days prior to registration

Trial Contact Information

Trial Lead Organizations/Sponsors

Academic and Community Cancer Research United

    Thomas Stinchcombe, M.D., Study Chair

    Trial Sites



    Illinois Cancer Care, PC

    Nancy J Williams
    Ph: 309-243-3614

    Sachdev P Thomas, MD
    Principal Investigator


    Carle Cancer Center at Carle Foundation Hospital

    Carle Cancer Center Research
    Ph: 217-383-3516

    James R. Egner, M.D.
    Principal Investigator

    Grand Rapids

    Grand Rapids Clinical Oncology Program

    Connie Szczepanek, RN, BSN
    Ph: 616-391-1230

    Gilbert DA Padula, M.D.
    Principal Investigator


    Academic and Community Cancer Research United

    Thomas E. Stinchcombe
    Ph: 919-966-9268

    Thomas E. Stinchcombe, MD
    Principal Investigator

    St. Cloud

    Coborn Cancer Center / CentraCare Clinic

    Stacy Veches, RN, BSN
    Ph: 320-229-5199Ext. 70826

    Donald J Jurgens, MD
    Principal Investigator

    New Hampshire

    NH Oncology - Hematology, PA

    NHOH Clinical Trial Office
    Ph: 603-232-8908

    Douglas Jay Weckstein
    Principal Investigator

    New York

    SUNY Upstate Medical University/Upstate Cancer Center

    Diane Gould, AAS
    Ph: 315-464-8235

    Stephen Graziano, M.D.
    Principal Investigator

    North Carolina
    Chapel Hill

    Lineberger Comprehensive Cancer Center at University of North Carolina - Chapel Hill

    Sara M. Gulino, MS, CCRP
    Ph: 919-966-4432Ext. 243

    Thomas E. Stinchcombe, MD
    Principal Investigator


    Duke Cancer Institute

    Jeffrey Crawford, M.D.
    Ph: 919-681-9509

    Jeffrey Crawford, M.D.
    Principal Investigator

    North Dakota

    Sanford Health / Roger Maris Cancer Center

    Amber Leach
    Ph: 701-234-5899

    Preston D. Steen, M.D.
    Principal Investigator


    Arthur G. James Cancer Hospital and Richard J. Solove Research Institute at Ohio State University Comprehensive Cancer Center

    Ben T Shoemaker, BS
    Ph: 614-366-6413

    Gregory A. Otterson
    Principal Investigator


    CCOP - Dayton

    Cara M Nolan
    Ph: 937-775-1354

    Howard M. Gross
    Principal Investigator

    South Carolina

    Gibbs Regional Cancer Center at Spartanburg Regional Medical Center

    Bunny B. McKnown, RN
    Ph: 864-560-6812

    James Dewitt Bearden
    Principal Investigator

    South Dakota
    Rapid City

    Regional Cancer Care Institute

    Amy Boylan, RN
    Ph: 605-719-2325

    Richard C Tenglin, MD
    Principal Investigator

    Sioux Falls

    Sanford Cancer Center at Sanford USD Medical Center

    Janet Wernisch, RN
    Ph: 605-328-1368

    Miroslaw A. Mazurczak
    Principal Investigator

    Green Bay

    St. Vincent Hospital Regional Cancer Center

    Jolene Cheslock, MS
    Ph: 920-433-8272

    Anthony Jaslowski, MD
    Principal Investigator

    Link to the current record.
    NLM Identifier NCT01532089 processed this data on April 09, 2015

    Note: Information about this trial is from the database. The versions designated for health professionals and patients contain the same text. Minor changes may be made to the record to standardize the names of study sponsors, sites, and contacts. only lists sites that are recruiting patients for active trials, whereas lists all sites for all trials. Questions and comments regarding the presented information should be directed to