STEREOtactic Radiation and Chemotherapy in Lung Cancer (STEREO)

University of Louisville (UOFL)

Status

Withdrawn

Conditions

Non-small Cell Lung Cancer (NSCLC)

Treatments

Radiation: Stereotactic Body Radiation Therapy

Study type

Interventional

Funder types

Other

Identifiers

NCT01300299

BCC-LUN-10-STEREO

Details and patient eligibility

About

This trial will test the feasibility of adjuvant chemotherapy after stereotactic body radiation therapy for early stage non-small cell lung cancer (NSCLC).

Full description

This study evaluates the effect of adjuvant chemotherapy in patients who received treatment with stereotactic radiation for early stage lung cancer and who are at high risk for microscopic metastatic disease.

Chemotherapy in the form of cisplatin/docetaxel or cisplatin/pemetrexed will be administered approximately six weeks after Stereotactic Body Radiation Therapy (SBRT). Patients will then undergo follow up clinical evaluation and imaging to evaluate treatment response and for surveillance.

A patient population of 65 patients will be required. Enrollment in this protocol is planned by multi center involvement in the state of Kentucky as part of the Kentucky Trial Network (KTN).

Sex

All

Ages

18+ years old

Volunteers

No Healthy Volunteers

Inclusion criteria

Age ≥ 18 years
Eastern Cooperative Oncology Group (ECOG) performance status 0-1
Histologically diagnosed non-small cell lung cancer(NSCLC, cT1-T3 (<= 5cm) (AJCC 7ed). The following histologies are eligible: squamous cell carcinoma, adenocarcinoma, large cell carcinoma, large cell neuroendocrine, or non-small cell carcinoma not otherwise specified; bronchioloalveolar cell carcinoma is a subtype of NSCLC but will be excluded from this study because assessment of multifocal disease spread through the airways is difficult.
Required CT of the chest and abdomen with contrast unless medically contraindicated (evaluating both lungs, mediastinum, liver, and adrenals) and Whole Body Positron Emission Tomography (PET) for staging. An integrated PET/Computed Tomography (CT) will meet the CT and PET requirements for staging. Images must be read by a trained radiologist and performed 8 weeks prior to initiation of treatment. PET imaging must allow adequate visualization of the primary tumor, draining lymphatics in hilar and mediastinum, adrenals, and skeleton.

Note: Per Radiation Therapy Oncology Group (RTOG) 0915 inclusion criteria, patients with hilar or mediastinal lymph nodes ≤ 1cm and no abnormal hilar or mediastinal uptake on PET will be considered N0. Patients with > 1 cm hilar or mediastinal lymph nodes on CT or abnormal PET (including suspicious but non-diagnostic uptake) may still be eligible if directed tissue biopsy of all abnormally identified areas are negative for cancer.

Deemed medically inoperable by an experienced thoracic cancer clinician for a standard lobectomy and lymph node sampling/dissection. Inoperability may be defined utilizing a number of criteria. These include any of the following:
Pretreatment Forced Expiratory Volume (FEV1) < 40% predicted
Postoperative FEV1 < 30% predicted
Severely reduced diffusion capacity
Baseline hypoxemia and/or hypercapnia
Exercise oxygen consumption < 50% predicted
Severe pulmonary hypertension
Diabetes mellitus with severe end organ damage
Severe cerebral, cardiac, or peripheral vascular disease
Decline surgery after evaluation by a thoracic surgeon

Required laboratory values within 2 weeks of chemotherapy initiation

Absolute neutrophil count (ANC) ≥ 1500 mm3
Platelets ≥ 100,000/mm3
Total Bilirubin ≤ 1.5 mg/dL
Serum glutamic oxaloacetic transaminase (SGOT)- aspartate aminotransferase (AST) < 5 x upper limit of normal (ULN}
Serum glutamic pyruvic transaminase (SGPT)- alanine transaminase(ALT) < 5 x upper limit of normal (ULN)
Serum Creatinine ≤ 1.5 x institutional upper limit of normal (ULN)
For patients assigned to pemetrexed/Cisplatin therapy calculated Creatinine Clearance (CrCl) must be obtained within 2 weeks of randomization and calculated CrCl must be > 45mL/min using the standard Cockcroft and Gault formula

Exclusion criteria

Primary lesion size not within the acceptable criteria
Evidence of regional metastases or distant metastases following appropriate staging
Previous radiation to the chest
Chemotherapy within the previous five years
Previous surgery for this particular lung tumor
Plans for concomitant chemotherapy with radiation
Active systemic or pulmonary infection
Pregnant or lactating females
Synchronous primary malignancy or prior malignancy in the past 2 years except for invasive malignancy that has been treated definitively and the patient remains disease free for > 3 years with life expectancy > 3 years. Previous skin cancers and carcinoma in situ treated definitively are acceptable.
Patients assigned to pemetrexed/cisplatin therapy must NOT have squamous cell histology
Bronchioloalveolar cell carcinoma is excluded because assessment of multifocal disease spread through the airways is difficult
Receipt of any other investigational agents or participation in any other investigational drug study within 4 weeks preceding initiation of study treatment