Studying Genes in Blood and Lung Fluid Samples From Patients With Chronic Obstructive Pulmonary Disease With or Without a Previous Diagnosis of Lung Cancer or With Asthma Treated With Budesonide and Formoterol

British Columbia Cancer Agency

Status and phase

Completed

Phase 1

Conditions

Precancerous Condition

Lung Cancer

Treatments

Other: laboratory biomarker analysis

Genetic: comparative genomic hybridization

Other: immunoenzyme technique

Procedure: bronchoscopy

Other: bronchoalveolar lavage

Drug: budesonide/formoterol fumarate dihydrate inhalation aerosol

Genetic: microarray analysis

Genetic: DNA methylation analysis

Study type

Interventional

Funder types

Other

Industry

Identifiers

NCT00569712

CDR0000577434

BCCA-H06-00209

ZENECA-BCCA-H06-00209

Details and patient eligibility

About

RATIONALE: Studying the genes expressed in samples of blood and lung fluid in the laboratory from patients receiving budesonide and formoterol may help doctors learn more about the effect of budesonide and formoterol on gene expression and biomarkers.

PURPOSE: This clinical trial is studying genes in blood and lung fluid samples from patients with chronic obstructive pulmonary disease, with or without a previous diagnosis of lung cancer, or with asthma treated with budesonide and formoterol.

Full description

OBJECTIVES:

To collect and integrate background information on the genetic, epigenetic, and gene expression profiles of small airway cells and markers of inflammation in bronchoalveolar lavage fluid and blood from patients with chronic obstructive pulmonary disease (COPD) with or without a prior diagnosis of lung cancer and from patients with asthma.
To examine the effects of budesonide/formoterol fumarate dihydrate inhalation aerosol (Symbicort Turbuhaler) on methylation and gene expression profiles of airway cells as well as on inflammatory, oxidant, and other pathways in these patients.
To determine if it would be feasible to conduct a larger study that would allow a definitive analysis of the differences in the bronchial cells and the inflammatory proteins in bronchial secretions and blood from patients with COPD with or without a prior diagnosis of lung cancer.

OUTLINE: Patients receive budesonide/formoterol fumarate dihydrate inhalation aerosol (Symbicort Turbuhaler) twice daily for 4 weeks in the absence of disease progression or unacceptable toxicities.

Patients undergo blood sample collection and bronchoscopy at baseline and at 4 weeks. Blood and bronchoalveolar fluid samples are analyzed for inflammatory biomarker measurements. Bronchial brushing cell samples are analyzed by comparative genomic hybridization array, whole genome methylation array, and gene expression profiling.

After completion of study treatment, patients are followed at 1 week by telephone interview.

Enrollment

30 patients

Sex

All

Ages

45 to 74 years old

Volunteers

No Healthy Volunteers

Inclusion and exclusion criteria

DISEASE CHARACTERISTICS:

Meets 1 of the following criteria:
- Former smoker with a 30 pack-year smoking history and mild to moderate degree of airflow obstruction, meeting the following criterion:
  - GOLD class 1 or 2 chronic obstructive pulmonary disease (COPD), defined as a post-bronchodilator FEV_1 < 80% of predicted and FEV_1 to FVC ratio < 70%
- Former smoker with COPD and has undergone a prior curative resection for stage 0 or I non-small cell lung cancer
- Non-smoker with mild to moderate bronchial asthma not already on inhaled corticosteroids, meeting the following criterion:
  - Fully reversible airflow obstruction and post-bronchodilator FEV_1 > 80% of predicted
No invasive cancer on bronchoscopy or abnormal spiral chest CT scan suspicious of lung cancer

PATIENT CHARACTERISTICS:

ECOG performance status 0-1
Not pregnant or nursing
Fertile patients must use effective contraception
Willing to use study drug twice daily regularly
Willing to undergo a bronchoscopy
Not planning to donate blood during study participation
No known or suspected hypersensitivity to budesonide, formoterol fumarate dihydrate, or excipients in study drug
No known reaction to xylocaine
No history of allergy to Symbicort, Pulmicort, or Oxeze Turbuhaler
No significant medical condition, such as acute or chronic respiratory failure, unstable angina, uncontrolled congestive heart failure, or bleeding disorder that, in the opinion of the investigator, may either put the patient at risk due to study participation or preclude the patient's ability to complete the study
No travel or planned hospitalization that would preclude the patient's ability to complete the study

PRIOR CONCURRENT THERAPY:

More than 6 months since prior and no other concurrent inhaled corticosteroids (e.g., budesonide [Pulmicort Turbuhaler], fluticasone [Flovent], beclomethasone dipropionate [QVAR], or fluticasone/salmeterol [Advair])
More than 6 months since prior and no concurrent oral steroids (e.g., prednisone)
No concurrent montelukast
No concurrent immunomodulatory or immunosuppressive medication (e.g., anti-TNF or methotrexate)
No concurrent beta-adrenergic blockers (e.g., atenolol or inderal), orally or as eye drops