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Non Small Cell Lung CancerPhase 2NCT00349089

Trial on Refinement of Early Stage Lung Cancer Adjuvant Therapy

A Phase 2 study testing Pemetrexed, Cisplatin and Vinorelbine in people with Non Small Cell Lung Cancer, run by Thoraxklinik-Heidelberg gGmbH at 14 sites in 3 countries.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The purpose of this randomized phase II trial is to determine the clinical feasibility - in terms of patients without dose limiting toxicities or premature treatment withdrawal or death - of the combination of Cisplatin and Pemetrexed and of the combination of Cisplatin and Vinorelbine. Read more about this study

Who is it for?
Ages 18 to 74 years
Conditions the study is for
Non Small Cell Lung Cancer
What is being tested?
Pemetrexed, Cisplatin and Vinorelbine
Could I receive a placebo?
No, everyone receives an active treatment
How many people
132 participants
Where
14 sitesin 3 countries
Study dates
26 Sep 2006to 14 Apr 2014
Phase
Phase 2
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 74 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Histopathologically confirmed diagnosis of non-small cell lung cancer (NSCLC), pathologic stage IB, IIA, IIB or T3N1 (without need for further radiotherapy).
  • Complete tumor resection without detectable residual tumor including negative margins (R0) and systematic intraoperative dissection of mediastinal lymph nodes of course lymph node dissection has to comprise all lymph node levels to be removed with standard right or left sided resection. The dissection has to assure the removal of mediastinal lymph nodes more than 1,5 cm on the preoperative CT scan.
  • Study drug administration should only be administered to patients with full recovery after surgery and is to begin on d28 to d42 postoperatively
  • The following histological tumor types are eligible:
  • Squamous Cell Carcinoma
  • Adenocarcinoma (including adenocarcinomas with bronchioloalveolar differentiation)
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  • Large Cell Carcinoma (excluding tumors with slight areas of small cell carcinoma)
  • Mixed Cell Carcinoma without small cell fraction
  • Provision of informed consent according to local regulatory requirements for participation in the study
  • Age ≥ 18 years; < 75 Years
  • Karnofsky Performance Status 80% or ECOG 1
  • Adequate hematological laboratory parameters
  • Hemoglobin 10 g/dl
  • ANC 1500/µl
  • Platelets 100000/µl
  • Adequate hepatic laboratory parameters
  • Bilirubin 1.5 x UNL (UNL=Upper Normal Limit )
  • ASAT/ALAT 2 x UNL
  • Adequate renal laboratory parameters
  • Creatinine 1,5 mg/dl and
  • Calculated Creatinine Clearance 60 ml/min
  • Cardiac function allowing cisplatin chemotherapy (in case of doubt echocardiography is mandatory documenting LVEF >49%)
  • Electrocardiogram without significant cardiac arrhythmia
  • FEV1 1.2 l post-operatively
  • Respiratory function not impeding Cisplatin-based chemotherapy assessed by either absolute DLCO or capillary / arterial BGA in resting condition (absolute DLCO > 40 % or pO2 >60 mmHg in resting condition)
  • Agreement by the patient to use an effective method of contraception
  • Negative pregnancy test for women of childbearing potential unless they are postmenopausal at baseline. (Postmenopausal women must have been amenorrheic at least for 12 months to be considered of non childbearing potential)

Who cannot join

  • Presence of a Pancoast tumor
  • Involvement of N2/N3 lymph nodes
  • Distant metastases
  • The following histological tumor types are excluded
  • Pure bronchioloalveolar carcinoma
  • Mixed cell carcinoma with small cell fractions
Show all 33Show fewer
  • Large Cell Carcinoma with areas of small cell carcinoma
  • Pregnancy or lactation period
  • Other co-existing malignancies or malignancies diagnosed within the last 5 years with the exception of a CIS of the cervix or non-melanomatous skin cancer. Patients curatively treated and free of disease for at least 5 years will be discussed with the Principal Investigator (LKP) before inclusion.
  • Radio- and/or chemotherapy within the last five years
  • Concurrent administration of any other antitumor therapy
  • Patients who are not compliant with vitamin (folic acid and vitamin B12) intake or to whom administration is not possible
  • Hypersensitivity to Pemetrexed or to any of the excipients of Alimta®
  • Hypersensitivity to Cisplatin or to any other platinum compound
  • Hypersensitivity to Vinorelbin or to any other vinca-alkaloid
  • Patient has previously completed or withdrawn from this study or any other study with the respective medication in this study
  • Treatment with an investigational new drug, currently or within the last 30 days, and/or participation in another clinical trial, currently or during the last 12 weeks, and/or previous participation in this study
  • History of a psychological illness or condition such as to interfere with the patient s ability to understand the requirements of the study
  • Patients with any clinically significant disease that in the opinion of the investigator is likely to put the patient at risk or to interfere with the evaluation of the patient's safety and of the study outcome. This includes, but is not limited to:
  • Clinically significant cardiac disease (e.g. congestive heart failure, symptomatic coronary artery disease and cardiac arrhythmia not well controlled with medication) or myocardial infarction within the last 6 months
  • Uncontrolled hypertension
  • Interstitial pneumonia or extensive or symptomatic interstitial fibrosis of the lung
  • pleural effusion or ascites, which cause respiratory compromise. Patients with sero(pneumo)-thorax after hemi-pneumonectomy or lobectomy will not be excluded. Those patients must be monitored for toxicity closely
  • Any other active or uncontrolled infection
  • Organ allografts
  • Patients with neurologic disorders
  • A history or presence of any CNS disorder or psychiatric disability judged by the Investigator to be clinically significant and/or interfering with compliance
  • A serious concomitant systemic disorder (e.g. active infection including HIV) that in the opinion of the investigator would compromise the patient s ability to complete the study
  • Post-operative complications or other surgery-related conditions that could interfere with a study participation
  • Hearing function / tinnitus impeding chemotherapy with Cisplatin and / or Vinorelbine
  • Alcohol and/or drug abuse
  • Patient is unable to interrupt high dose salicylates (like aspirin) or other non-steroidal anti-inflammatory drugs (NSAID´s) for a 5-day period starting 2 days before administration of Pemetrexed (8-day period for long-acting agents such as piroxicam)
  • Patients who cannot be regularly observed for psychological, sociological or geographical reasons or other concomitant conditions not permitting adequate follow-up and compliance to the protocol

Trial locations and contacts

14 sites in 3 countries.

14 sites in 3 countries

Germany11 sites

  • Helios-Klinikum Emil von Behring

    Berlin, 14109

  • Klinikum Bremen-Ost

    Bremen, 28325

  • Westdeutsches Tumorzentrum

    Essen, 45122

  • Department of Hematology and Oncology, University of Göttingen

    Göttingen, 37075

  • Lungenzentrum Großhansdorf

    Großhansdorf, 22927

  • Clinic for thoracic diseases at the University of Heidelberg

    Heidelberg, 69120

  • Lungenklinik Hemer

    Hemer, 58675

  • Klinik Löwenstein

    Löwenstein, 74245

  • University of München

    München

  • Oldenburg Hospital

    Oldenburg

  • Dr. Horst Schmidt Klinik

    Wiesbaden, 65199

Other trials in Germany

Belgium2 sites

  • Ziekenhuis Oost Limburg

    Genk, 3600

  • Department of Pulmonology (Respiratory Tumor Unit), University Hospital Gasthuisberg, Catholic University Leuven, Belgium.

    Leuven, 3000

Other trials in Belgium

Luxembourg1 site

  • Centre Hospitalier du Luxembourg

    Luxembourg, L-1210

Other trials in Luxembourg

About this study

Official title: Adjuvant Chemotherapy With Pemetrexed and Cisplatin vs. Vinorelbine and Cisplatin in NSCLC IB, IIA, IIB, T3N1: a Randomized Phase II Study

The purpose of this randomized phase II trial is to determine the clinical feasibility - in terms of patients without dose limiting toxicities or premature treatment withdrawal or death - of the combination of Cisplatin and Pemetrexed and of the combination of Cisplatin and Vinorelbine. The combination of Cisplatin / Pemetrexed is assumed to be distinctly less toxic than Vinorelbine / Cisplatin.

Read the detailed description

Derived from recent large randomized clinical trials, there is clear evidence for adjuvant chemotherapy in stage IB-IIB (incidental IIIA) non-small cell lung cancer (Arriagada et al., 2004; Winton et al., 2005, Strauss et al., 2004, Douillard et al., 2005). The majority of patients in the adjuvant treatment setting received a combination of Cisplatin and Vinorelbine (Aragiada et al., 2004; Winton et al., 2005; Douillard et al., 2005). This combination improved 5 year-survival rates up to 15% (54% to 69%) (Winton et al., 2005). However, the combination of Cisplatin and Vinorelbine resulted in rates of grade 3/4 neutropenia of around 75%, rates of febrile neutropenia of up to 12.5% and rates of treatment related death of 1-2%. Up to 77% of the patients had at least one dose reduction or omission and 55% required one dose delay or more, most related to neutropenia. Only about 50 % of patients randomized on the combination of cisplatin and vinorelbine received the intended dose of Vinorelbine (dose reduction mainly due to toxicity) and only 50% of patients completed all four cycles of chemotherapy (Winton et al., 2005, Douillard et al., 2005, Alam et al., 2005).

Therefore it seems reasonable to test a less toxic regimen also in early stages after R0 resection of the tumor, where reduced toxicities might improve the feasibility of drug delivery, compliance and the convenience of treatment for the patient and hence perhaps survival.

Pemetrexed, a folate antimetabolite, shows clear activity in non-small cell lung cancer with several Phase II studies of Pemetrexed in combination with Cisplatin, Oxaliplatin, or Carboplatin showing efficacy similar to other standard platinum doublets, with response rates of 27% to 45% and median survival of 8.9 to 10.9 months (Scagliotti et al., 2005; Clarke et al., 2002; Rusthoven et al., 1999; Manegold et al., 2000; Shepherd et al., 2001). The combination of platin and Pemetrexed can be easily delivered and is well tolerated. Furthermore, it only results in a 25% rate of grade 3/4 neutropenia and in vitamin supplemented patients the incidence of febrile neutropenia was < 1%. Dose reductions occur only in 2-4% of the patients and dose delivery of the intended Pemetrexed and platin dose is excellent with dose deliveries of Pemetrexed up to 95% (Hanna et al., 2004; Vogelzang et al., 2003, Scagliotti et al., 2005).

In this randomized phase II trial, the clinical feasibility of the combination of Cisplatin and Pemetrexed as well as of the combination of Cisplatin and Vinorelbine will be assessed. Treatment is considered to have clinical feasibility if dose limiting toxicity will not be observed, and no non-acceptance by the patient leading to premature withdrawal, and no death due to cancer or cancer therapy will occur.

Patients will be randomized according to center, lobectomy vs. pneumonectomy and N0 vs. N1 to 4 cycles (arm A) of 500 mg/m2 pemetrexed d1, and Cisplatin 75 mg/m2 d1, q d22 versus (arm B) 25 mg/m2 Vinorelbine d1, 8, 15, 22, and Cisplatin 50 mg/m2 d1+8; q d29. Radiotherapy or maintenance therapy are not intended. Study drug administration will begin on d28 to d42 after R0 resection of the tumor and within 14 days after randomization.

In an initial study phase 36 patients (i.e. 18 in each treatment arm) will be accrued to confirm feasibility. In the second step, further patients will be recruited up to a total number of 134 (i.e. 67 cases per treatment arm). Patients will be followed-up in 3 monthly intervals for the first 2 years starting 30 days after end of the last cycle and in the 3rd year patients will be followed-up in 6 monthly intervals.

Keywords
Non-small cell lung cancer, adjuvant therapy, clinical feasibility rate
Medical subject headings
Carcinoma, Non-Small-Cell Lung

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • PemetrexedDrug

    Pemetrexed 500 mg/m2 d1 and Cisplatin 75 mg/m2 d1; q d22

  • CisplatinDrug

    Pemetrexed 500 mg/m2 d1 and Cisplatin 75 mg/m2 d1; q d22

    Comparator:

    Vinorelbine 25 mg/m2 d1, 8, 15, 22; q d29 Cisplatin 50 mg/m2 d1, 8; q d29

  • VinorelbineDrug

    Vinorelbine 25 mg/m2 d1, 8, 15, 22; q d29

Study groups in NCT00349089
Study groupRoleWhat they receive
1Active comparatorCisplatin/Vinorelbine
Receives: Drug: Cisplatin; Drug: Vinorelbine
2ExperimentalCisplatin/Pemetrexed
Receives: Drug: Pemetrexed; Drug: Cisplatin

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. To determine the clinical feasibility rate of 4 cycles of adjuvant chemotherapy with Pemetrexed and Cisplatin vs. Vinorelbine and Cisplatin

    Measured: 4 month

Secondary outcomes (8)

  1. To determine and compare the drug delivery between both treatment arms

    Measured: 4 month

  2. To determine the Time to Treatment Failure (TTTF)

    Measured: 3 years

  3. To determine the Distant Metastases Free Survival (DMFS)

    Measured: 3 years

  4. To determine the Local Relapse Free Survival (LRFS)

    Measured: 3 years

  5. To determine the Overall Survival (OS)

    Measured: 3 years

  6. To determine the Localization of Relapse

    Measured: 3 years

  7. To determine dose delivery

    Measured: 3 years

  8. To determine the Relapse Free Survival (RFS)

    Measured: 3 years

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted6 Jul 2006 (estimated)
  2. Study start26 Sep 2006
  3. Primary completion14 Apr 2014
  4. Study completion14 Apr 2014

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
132 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT00349089
Sponsor's protocol ID
TREAT
Other IDs
2005-004840-30, 2005
Status last verified
Sep 2019
First submitted
4 Jul 2006
Last updated
19 Sep 2019
Results posted
No
Data monitoring committee
Yes

Publications

  • Winton T, Livingston R, Johnson D, Rigas J, Johnston M, Butts C, Cormier Y, Goss G, Inculet R, Vallieres E, Fry W, Bethune D, Ayoub J, Ding K, Seymour L, Graham B, Tsao MS, Gandara D, Kesler K, Demmy T, Shepherd F; National Cancer Institute of Canada Clinical Trials Group; National Cancer Institute of the United States Intergroup JBR.10 Trial Investigators. Vinorelbine plus cisplatin vs. observation in resected non-small-cell lung cancer. N Engl J Med. 2005 Jun 23;352(25):2589-97. doi: 10.1056/NEJMoa043623.

    PubMed 15972865

  • Alam N, Shepherd FA, Winton T, Graham B, Johnson D, Livingston R, Rigas J, Whitehead M, Ding K, Seymour L. Compliance with post-operative adjuvant chemotherapy in non-small cell lung cancer. An analysis of National Cancer Institute of Canada and intergroup trial JBR.10 and a review of the literature. Lung Cancer. 2005 Mar;47(3):385-94. doi: 10.1016/j.lungcan.2004.08.016.

    PubMed 15713522

  • Arriagada R, Bergman B, Dunant A, Le Chevalier T, Pignon JP, Vansteenkiste J; International Adjuvant Lung Cancer Trial Collaborative Group. Cisplatin-based adjuvant chemotherapy in patients with completely resected non-small-cell lung cancer. N Engl J Med. 2004 Jan 22;350(4):351-60. doi: 10.1056/NEJMoa031644.

    PubMed 14736927

  • Strauss G, Herndon J, Maddaus MA, et al. Randomized clinical trial of adjuvant chemotherapy with Paclitaxel and Carboplatin following resection in stage I B non-small cell lung cancer (NSCLC): Report of Cancer and Leukaemia Group B (CALGB) protocol 9633. Proc Am Soc Clin Oncol 22: 621 (# 7019)2004

  • Douillard J, Rosell R, Delena M, et al. ANITA: Phase III adjuvant Vinorelbine and Cisplatin versus observation in completely resected (stage I-III) non-small lung cancer patients: Final results after 70-month median follow up. Proc Am Soc Clin Oncol 23: 624 (# 7013) 2005

  • Kreuter M, Vansteenkiste J, Griesinger F, Hoffmann H, Dienemann H, De Leyn P, Thomas M. Trial on refinement of early stage non-small cell lung cancer. Adjuvant chemotherapy with pemetrexed and cisplatin versus vinorelbine and cisplatin: the TREAT protocol. BMC Cancer. 2007 May 8;7:77. doi: 10.1186/1471-2407-7-77.

    PubMed 17488518

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Pemetrexed, Cisplatin and Vinorelbine in people with Non Small Cell Lung Cancer, run by Thoraxklinik-Heidelberg gGmbH at 14 sites in 3 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 27 inclusion and 33 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 19 Sep 2019. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 14 sites in Germany, Belgium, Luxembourg. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

To determine the clinical feasibility rate of 4 cycles of adjuvant chemotherapy with Pemetrexed and Cisplatin vs. Vinorelbine and Cisplatin (time frame: 4 month). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT00349089, which also lists 6 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 19 Sep 2019.

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