Neoadjuvant Chemoradiotherapy Followed By Surgery in Treating Patients With Limited-Stage Small Cell Lung Cancer

Temple University Health System (TUHS)

Status and phase

Completed

Phase 1

Conditions

Lung Cancer

Treatments

Drug: irinotecan hydrochloride

Drug: cisplatin

Procedure: neoadjuvant therapy

Radiation: radiation therapy

Procedure: conventional surgery

Study type

Interventional

Funder types

Other

NIH

Identifiers

NCT00062322

P30CA006927 (U.S. NIH Grant/Contract)

FCCC-02613

CDR0000304720

Details and patient eligibility

About

RATIONALE: Drugs used in chemotherapy such as irinotecan and cisplatin use different ways to stop tumor cells from dividing so they stop growing or die. Radiation therapy uses high-energy x-rays to damage tumor cells. Irinotecan and cisplatin may also make the tumor cells more sensitive to radiation therapy. Combining chemotherapy with radiation therapy before surgery may shrink the tumor so that it can be removed during surgery.

PURPOSE: This phase I trial is studying the side effects of neoadjuvant radiation therapy given together with irinotecan and cisplatin followed by surgery in treating patients with limited-stage small cell lung cancer.

Full description

OBJECTIVES:

Determine the safety and feasibility of neoadjuvant chemoradiotherapy with irinotecan and cisplatin followed by surgery in patients with limited stage small cell lung cancer.
Determine the pathologic complete response rate of patients treated with this regimen.
Correlate the level of vascular endothelial growth factor with treatment response and disease outcome in patients treated with this regimen.
Correlate genetic polymorphisms in cytochrome P450 1A1, glutathione S-transferase M1 and P1, myeloperoxidase, and NAD(p)H: quinone oxidoreductase with treatment response and disease outcome in patients treated with this regimen.

OUTLINE: This is a pilot study.

Induction chemotherapy: Patients receive cisplatin IV over 1 hour on day 1 and irinotecan IV over 90 minutes on days 1 and 8.
Chemoradiotherapy: Beginning on day 21, patients receive chemoradiotherapy comprising radiotherapy once daily, 5 days a week for 4 weeks and then twice daily for 4 days. Patients also receive cisplatin IV and irinotecan IV over 30-60 minutes once weekly concurrently with radiotherapy. Treatment continues in the absence of disease progression or unacceptable toxicity.

At the completion of chemoradiotherapy, patients are evaluated for surgery. Patients who are candidates for surgery receive one additional course of cisplatin IV and irinotecan IV. Patients who are not candidates for surgery receive radiotherapy twice daily for 4 days and cisplatin IV and irinotecan IV as in chemoradiotherapy.

Surgery: Approximately 2-4 weeks after the last dose of chemotherapy, patients undergo surgery.

Patients are followed every 4 months for 2 years and then every 6 months for 3 years.

PROJECTED ACCRUAL: A total of 20 patients will be accrued for this study.

Sex

All

Ages

18+ years old

Volunteers

No Healthy Volunteers

Inclusion and exclusion criteria

DISEASE CHARACTERISTICS:

Histologically or cytologically confirmed small cell lung cancer
- Limited stage disease (clinical stage I-IIIA) and meets the following criteria:
  - Confined to 1 hemithorax
  - No T4 disease based on malignant pleural effusion
  - No N3 disease based on contralateral hilar or supraclavicular involvement
- Contralateral mediastinal (N3) nodes greater than 1.5 cm on CT scan must be biopsied to rule out pathologic involvement
Measurable or evaluable disease
Tumor must be able to be encompassed by limited radiotherapy field without significantly compromising pulmonary function
No pleural effusion visible on chest x-ray (regardless of cytology)
No prior complete tumor resection

PATIENT CHARACTERISTICS:

Age

18 and over

Performance status

Karnofsky 70-100%

Life expectancy

Not specified

Hematopoietic

Absolute granulocyte count at least 1,800/mm^3
Platelet count at least 100,000/mm^3

Hepatic

Bilirubin no greater than 1.5 mg/dL
No known Gilbert's disease

Renal

Creatinine no greater than 1.5 mg/dL
Calcium less than 12.0 mg/dL

Cardiovascular

No myocardial infarction within the past 6 months
No congestive heart failure
No uncontrolled arrhythmias
No active unstable angina

Pulmonary

Calculated postoperative FEV_1 at least 800 cc
No chronic obstructive pulmonary disease with FEV_1 no greater than 1 L or uncontrolled bronchospasm in the unaffected lung

Other

Not pregnant
Negative pregnancy test
Fertile patients must use effective contraception
No other malignancy within the past 2 years except curatively treated basal cell or squamous cell skin cancer, carcinoma in situ of the cervix, or any other noninvasive malignancy
No history of seizures
No history of uncontrolled psychiatric illness that would preclude giving informed consent or complying with study
No active or uncontrolled infection
No uncontrolled diabetes mellitus (random blood sugar at least 250 mg/dL)
No other concurrent serious medical illness
HIV negative

PRIOR CONCURRENT THERAPY:

Biologic therapy