Overview

Erlotinib Hydrochloride or Crizotinib and Chemoradiation Therapy in Treating Patients With Stage III Non-small Cell Lung Cancer

Status:
Terminated
Trial end date:
2018-06-04
Target enrollment:
0
Participant gender:
All
Summary
This randomized phase II trial studies how well erlotinib hydrochloride or crizotinib 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 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.
Phase:
Phase 2
Accepts Healthy Volunteers?
No
Details
Lead Sponsor:
National Cancer Institute (NCI)
Collaborator:
NRG Oncology
Treatments:
Albumin-Bound Paclitaxel
Carboplatin
Cisplatin
Crizotinib
Erlotinib Hydrochloride
Etoposide
Etoposide phosphate
Paclitaxel
Podophyllotoxin
Succinylcholine
Criteria
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 < 1.5 mg/dL or calculated creatinine clearance >= 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