Erlotinib Hydrochloride With or Without Carboplatin and Paclitaxel in Treating Patients With Stage III-IV Non-small Cell Lung Cancer

Phase 2

Completed

Conditions: Lung Adenocarcinoma
Stage IIIB Lung Non-Small Cell Cancer AJCC v7
Malignant Pericardial Effusion
Malignant Pleural Effusion
Lung Adenosquamous Carcinoma
Minimally Invasive Lung Adenocarcinoma
Stage IV Lung Non-Small Cell Cancer AJCC v7

Interventions: Drug: Erlotinib
Drug: Carboplatin
Drug: Erlotinib Hydrochloride
Drug: Paclitaxel

Registration Number: NCT00126581

Lead Sponsor: National Cancer Institute (NCI)

Brief Summary: This randomized phase II trial studies how well erlotinib hydrochloride with or without carboplatin and paclitaxel works in treating patients with stage III-IV non-small cell lung cancer. Erlotinib hydrochloride may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy, such as carboplatin and paclitaxel, 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. Giving erlotinib hydrochloride together with carboplatin and paclitaxel may kill more tumor cells than giving either drug alone.

Detailed Description: PRIMARY OBJECTIVES:

I. To determine the distribution of progression-free survival (PFS) in patients with previously untreated advanced adenocarcinoma of the lung who are never or light former smokers treated with either OSI-774 (erlotinib) (erlotinib hydrochloride) alone (arm A) or in combination with carboplatin/paclitaxel (arm B).

SECONDARY OBJECTIVES:

I. To determine the radiographic response rate in patients with previously untreated advanced adenocarcinoma of the lung who are never or light former smokers treated with either OSI-774 (erlotinib) alone (arm A) or in combination with carboplatin/paclitaxel (arm B).

II. To determine the frequency of epidermal growth factor receptor (EGFR) and V-Ki-ras2 Kirsten rat sarcoma viral oncogene homolog (K-ras) mutations and anaplastic lymphoma kinase (ALK) translocations in patients with previously untreated advanced adenocarcinoma of the lung who are never or light former smokers.

III. To determine the response rate and time to progression in patients with and without EGFR mutations treated with either OSI-774 (erlotinib) alone (arm A) or in combination with carboplatin/paclitaxel (arm B).

IV. To determine the response rate and time to progression in patients with and without K-ras mutations treated with either OSI-774 (erlotinib) alone (arm A) or in combination with carboplatin/paclitaxel (arm B).

V. To determine the median and overall survival of patients with previously untreated advanced adenocarcinoma of the lung who are never or light former smokers treated with either OSI-774 (erlotinib) alone (arm A) or in combination with carboplatin/paclitaxel (arm B).

VI. To estimate the response rate, progression-free, and overall survival of patients with echinoderm microtubule associated protein like (EML)4-ALK translocation who received OSI-774 erlotinib alone (arm A) or in combination with carboplatin/paclitaxel (arm B).

OUTLINE: Patients are randomized to 1 of 2 treatment arms.

ARM I: Patients receive erlotinib hydrochloride orally (PO) once daily (QD) on days 1-21. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity.

ARM II: Patients receive erlotinib hydrochloride as in Arm I. Patients also receive paclitaxel intravenously (IV) over 1-3 hours and carboplatin IV over 15-30 minutes on day 1. Treatment repeats every 21 days for up to 6 cycles in the absence of disease progression or unacceptable toxicity. After completion of 6 cycles of treatment, patients may continue to receive erlotinib hydrochloride alone as above.

After completion of study treatment, patients are followed at least every 3 months for 1 year and then every 6 months for up to 2 years.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 188

Inclusion Criteria

Histologic documentation of primary lung adenocarcinoma including any variant thereof such as pure or mixed bronchioloalveolar carcinoma or adenosquamous cell carcinoma; patients with non-small cell lung cancer (NSCLC) not otherwise specified (NOS) are not eligible
- Pathology block or unstained slides from initial or subsequent diagnosis must be available for sequencing of EGFR, K-ras, Erb-2 and B-raf; patients need to have had at least a core biopsy; patients whose diagnosis was made through a fine needle aspirate will not have sufficient material for mutational analysis and are not eligible
Select stage IIIB with cytologically documented malignant pleural or pericardial effusion OR stage IV disease
Patients must be chemotherapy naïve; they may not have received neo-adjuvant or adjuvant chemotherapy
No prior exposure to OSI-774 (erlotinib) or other treatments targeting the human epidermal growth factor receptor (HER) family axis (e.g., trastuzumab, gefitinib, cetuximab, lapatinib, etc.)
No uncontrolled central nervous system metastases (i.e., any known central nervous system [CNS] lesion which is radiographically unstable, symptomatic and/or requiring corticosteroids); patients must be >= 3 weeks beyond completing cranial irradiation and off corticosteroid therapy
>= 3 weeks since prior radiation therapy
>= 3 weeks since prior major surgery
No treatment with an investigational agent currently or within the last 28 days
Non-smoker or former light smoker; non-smoker is defined as a person who smoked =< 100 cigarettes in their lifetime while a former light smoker is a patient who smoked between > 100 cigarettes AND =< 10 pack years AND quit >= 1 year ago; this must be documented on the On-study Form (C-1405)
Eastern Cooperative Oncology Group (ECOG) 0 or 1
Non-pregnant and non-nursing
No dysphagia or active gastrointestinal disease or disorder that alters gastrointestinal motility or absorption; no lack of integrity of the gastrointestinal tract (e.g., a significant surgical resection of the stomach or small bowel); patients unable to swallow intact tablets must be able to swallow tablets dissolved in water
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 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
Granulocyte >= 1,500/mcl
Platelet count >= 100,000/mcl
Hemoglobin >= 9.0 g/dL
Total bilirubin =< upper limit of normal (ULN)
Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT]) =< 2.5 x ULN
Creatinine =< 1.5 mg/dl

Exclusion Criteria

Not provided

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Arm II (erlotinib hydrochloride, paclitaxel, carboplatin)	Erlotinib Hydrochloride	Patients receive erlotinib hydrochloride as in arm I. Patients also receive paclitaxel IV over 1-3 hours and carboplatin IV over 15-30 minutes on day 1. Treatment repeats every 21 days for up to 6 cycles in the absence of disease progression or unacceptable toxicity. After completion of 6 cycles of treatment, patients may continue to receive erlotinib hydrochloride alone as above.
Arm I (erlotinib hydrochloride)	Erlotinib Hydrochloride	Patients receive erlotinib hydrochloride PO QD on days 1-21. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity.
Arm I (erlotinib hydrochloride)	Erlotinib	Patients receive erlotinib hydrochloride PO QD on days 1-21. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity.
Arm II (erlotinib hydrochloride, paclitaxel, carboplatin)	Carboplatin	Patients receive erlotinib hydrochloride as in arm I. Patients also receive paclitaxel IV over 1-3 hours and carboplatin IV over 15-30 minutes on day 1. Treatment repeats every 21 days for up to 6 cycles in the absence of disease progression or unacceptable toxicity. After completion of 6 cycles of treatment, patients may continue to receive erlotinib hydrochloride alone as above.
Arm II (erlotinib hydrochloride, paclitaxel, carboplatin)	Erlotinib	Patients receive erlotinib hydrochloride as in arm I. Patients also receive paclitaxel IV over 1-3 hours and carboplatin IV over 15-30 minutes on day 1. Treatment repeats every 21 days for up to 6 cycles in the absence of disease progression or unacceptable toxicity. After completion of 6 cycles of treatment, patients may continue to receive erlotinib hydrochloride alone as above.
Arm II (erlotinib hydrochloride, paclitaxel, carboplatin)	Paclitaxel	Patients receive erlotinib hydrochloride as in arm I. Patients also receive paclitaxel IV over 1-3 hours and carboplatin IV over 15-30 minutes on day 1. Treatment repeats every 21 days for up to 6 cycles in the absence of disease progression or unacceptable toxicity. After completion of 6 cycles of treatment, patients may continue to receive erlotinib hydrochloride alone as above.

Primary Outcome Measures

Name	Time	Method
18 Weeks Progression Free Survival (PFS) Rate	At 18 weeks	The product limit estimator developed by Kaplan Meier will be used to graphically describe progression free survival for patients randomized to each study arm. The 18 week progression-free survival rate was defined as the proportion of patients that were alive progression-free 18 weeks after registration into the study. Disease progression was assessed per modified RECIST criteria, and defined as at least a 20% increase in the sum of the longest diameters of target lesions, in either primary or nodal lesions, taking as reference the smallest sum longest diameter recorded since the baseline measurements, or the appearance of new lesions. Kaplan-Meier estimate of 18-week progression-free survival was calculated.

Secondary Outcome Measures

Name	Time	Method
Number of Participants With Grade 3, 4 or 5 Adverse Event at Least Possibly Related to Treatment.	Duration of study (up to 3 years)	The National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) version 3. Grade 1: Mild; Grade 2: Moderate; Grade 3: Severe; Grade 4: Life Threatening; Grade 5: Death.
Overall Response Rate	Duration of Study (up to 3 years)	The proportion of patients who respond (completely or partially) to each combination regimen will be estimated. An exact binomial confidence interval will be computed for these estimates. Response was defined using Response Evaluation Criteria In Solid Tumors (RECIST) criteria: Complete Response (CR): disappearance of all target lesions; Partial Response (PR) 30% decrease in sum of longest diameter of target lesions

Trial Locations

Locations (96): University Medical Center of Southern Nevada
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Las Vegas, Nevada, United States
Kaiser Permanente-San Diego Mission
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San Diego, California, United States
Veterans Administration-San Diego Medical Center
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San Diego, California, United States
Duke University Medical Center
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Durham, North Carolina, United States
East Bay Radiation Oncology Center
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Castro Valley, California, United States
Eden Hospital Medical Center
🇺🇸
Castro Valley, California, United States
Valley Medical Oncology Consultants-Castro Valley
🇺🇸
Castro Valley, California, United States
Valley Medical Oncology Consultants-Fremont
🇺🇸
Fremont, California, United States
Bay Area Breast Surgeons Inc
🇺🇸
Emeryville, California, United States
Contra Costa Regional Medical Center
🇺🇸
Martinez, California, United States
El Camino Hospital
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Mountain View, California, United States
Alta Bates Summit Medical Center - Summit Campus
🇺🇸
Oakland, California, United States
Saint Rose Hospital
🇺🇸
Hayward, California, United States
Highland General Hospital
🇺🇸
Oakland, California, United States
Bay Area Tumor Institute
🇺🇸
Oakland, California, United States
Hematology and Oncology Associates-Oakland
🇺🇸
Oakland, California, United States
Tom K Lee Inc
🇺🇸
Oakland, California, United States
Valley Care Health System - Pleasanton
🇺🇸
Pleasanton, California, United States
Valley Medical Oncology Consultants
🇺🇸
Pleasanton, California, United States
Doctors Medical Center- JC Robinson Regional Cancer Center
🇺🇸
San Pablo, California, United States
Beebe Medical Center
🇺🇸
Lewes, Delaware, United States
MedStar Georgetown University Hospital
🇺🇸
Washington, District of Columbia, United States
MedStar Washington Hospital Center
🇺🇸
Washington, District of Columbia, United States
Holy Cross Hospital
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Fort Lauderdale, Florida, United States
Jupiter Medical Center
🇺🇸
Jupiter, Florida, United States
Memorial Health University Medical Center
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Savannah, Georgia, United States
Mount Sinai Medical Center
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Miami Beach, Florida, United States
Elkhart General Hospital
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Elkhart, Indiana, United States
Community Howard Regional Health
🇺🇸
Kokomo, Indiana, United States
University of Chicago Comprehensive Cancer Center
🇺🇸
Chicago, Illinois, United States
AMITA Health Adventist Medical Center
🇺🇸
La Grange, Illinois, United States
Saint Joseph Regional Medical Center-Mishawaka
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Mishawaka, Indiana, United States
Northern Indiana Cancer Research Consortium
🇺🇸
South Bend, Indiana, United States
IU Health La Porte Hospital
🇺🇸
La Porte, Indiana, United States
Memorial Hospital of South Bend
🇺🇸
South Bend, Indiana, United States
University of Iowa/Holden Comprehensive Cancer Center
🇺🇸
Iowa City, Iowa, United States
University of Maryland/Greenebaum Cancer Center
🇺🇸
Baltimore, Maryland, United States
MedStar Franklin Square Medical Center/Weinberg Cancer Institute
🇺🇸
Baltimore, Maryland, United States
Union Hospital of Cecil County
🇺🇸
Elkton, Maryland, United States
Massachusetts General Hospital Cancer Center
🇺🇸
Boston, Massachusetts, United States
Brigham and Women's Hospital
🇺🇸
Boston, Massachusetts, United States
Dana-Farber Cancer Institute
🇺🇸
Boston, Massachusetts, United States
Mass General/North Shore Cancer Center
🇺🇸
Danvers, Massachusetts, United States
Cape Cod Hospital
🇺🇸
Hyannis, Massachusetts, United States
Lowell General Hospital
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Lowell, Massachusetts, United States
South Shore Hospital
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South Weymouth, Massachusetts, United States
Missouri Cancer Associates
🇺🇸
Columbia, Missouri, United States
University of Minnesota/Masonic Cancer Center
🇺🇸
Minneapolis, Minnesota, United States
Lakeland Medical Center Saint Joseph
🇺🇸
Saint Joseph, Michigan, United States
Veterans Administration
🇺🇸
Columbia, Missouri, United States
Capital Region Medical Center
🇺🇸
Jefferson City, Missouri, United States
Center for Cancer Care and Research
🇺🇸
Saint Louis, Missouri, United States
University of Missouri - Ellis Fischel
🇺🇸
Columbia, Missouri, United States
Missouri Baptist Medical Center
🇺🇸
Saint Louis, Missouri, United States
Washington University School of Medicine
🇺🇸
Saint Louis, Missouri, United States
Great Plains Health Callahan Cancer Center
🇺🇸
North Platte, Nebraska, United States
CHI Health Saint Francis
🇺🇸
Grand Island, Nebraska, United States
Saint Joseph Hospital
🇺🇸
Nashua, New Hampshire, United States
Roswell Park Cancer Institute
🇺🇸
Buffalo, New York, United States
Hematology Oncology Associates of Central New York-East Syracuse
🇺🇸
East Syracuse, New York, United States
Long Island Jewish Medical Center
🇺🇸
New Hyde Park, New York, United States
Northwell Health NCORP
🇺🇸
Lake Success, New York, United States
UNC Lineberger Comprehensive Cancer Center
🇺🇸
Chapel Hill, North Carolina, United States
State University of New York Upstate Medical University
🇺🇸
Syracuse, New York, United States
Ralph Lauren Center for Cancer Care and Prevention
🇺🇸
New York, New York, United States
Memorial Sloan Kettering Cancer Center
🇺🇸
New York, New York, United States
Saint Joseph's Hospital Health Center
🇺🇸
Syracuse, New York, United States
Novant Health Presbyterian Medical Center
🇺🇸
Charlotte, North Carolina, United States
Wilson Medical Center
🇺🇸
Wilson, North Carolina, United States
Vidant Oncology-Kinston
🇺🇸
Kinston, North Carolina, United States
Wayne Memorial Hospital
🇺🇸
Goldsboro, North Carolina, United States
Ohio State University Comprehensive Cancer Center
🇺🇸
Columbus, Ohio, United States
Margaret R Pardee Memorial Hospital
🇺🇸
Hendersonville, North Carolina, United States
Wayne Radiation Oncology
🇺🇸
Goldsboro, North Carolina, United States
Memorial Hospital of Rhode Island
🇺🇸
Pawtucket, Rhode Island, United States
Greenville Memorial Hospital
🇺🇸
Greenville, South Carolina, United States
Miriam Hospital
🇺🇸
Providence, Rhode Island, United States
Roper Hospital
🇺🇸
Charleston, South Carolina, United States
McLeod Regional Medical Center
🇺🇸
Florence, South Carolina, United States
University of Vermont and State Agricultural College
🇺🇸
Burlington, Vermont, United States
Virginia Commonwealth University/Massey Cancer Center
🇺🇸
Richmond, Virginia, United States
Rutgers Cancer Institute of New Jersey
🇺🇸
New Brunswick, New Jersey, United States
North Shore University Hospital
🇺🇸
Manhasset, New York, United States
Middlesex Hospital
🇺🇸
Middletown, Connecticut, United States
Greenville Health System Cancer Institute-Eastside
🇺🇸
Greenville, South Carolina, United States
University of California San Diego
🇺🇸
San Diego, California, United States
Christiana Care Health System-Christiana Hospital
🇺🇸
Newark, Delaware, United States
Cooper Hospital University Medical Center
🇺🇸
Camden, New Jersey, United States
Central Vermont Medical Center/National Life Cancer Treatment
🇺🇸
Berlin, Vermont, United States
UCSF Medical Center-Mount Zion
🇺🇸
San Francisco, California, United States
University of Oklahoma Health Sciences Center
🇺🇸
Oklahoma City, Oklahoma, United States
Cancer Care Associates
🇺🇸
Oklahoma City, Oklahoma, United States
University of Nebraska Medical Center
🇺🇸
Omaha, Nebraska, United States
Rappahannock General Hospital
🇺🇸
Kilmarnock, Virginia, United States
Saint Francis Hospital
🇺🇸
Greenville, South Carolina, United States
Rhode Island Hospital
🇺🇸
Providence, Rhode Island, United States