Vinorelbine-ifosfamide Versus Gefitinib for EGFR Gene Mutation Negative Non-small Cell Lung Cancer Patients
Conditions
Non-small Cell Lung Cancer - Effects of Chemotherapy
Conditions: official terms
Carcinoma, Non-Small-Cell Lung - Lung Neoplasms
Conditions: Keywords
non small cell lung cancer, chemotherapy, gefitinib, vinorelbine, ifosfamide
Study Type
Interventional
Study Phase
Phase 2
Study Design
Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
Intervention
Name: Gefitinib group Type: Drug
Name: Vinorelbine, Ifosfamide, Mesna Type: Drug
Overall Status
Recruiting
Summary
In the National Comprehensive Cancer Network (NCCN) guideline for NSCLC, epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) is recommended as the third-line treatment for EGFR gene mutation negative NSCLC patients who failed to the first-line platinum doublet chemotherapy [i.e. paclitaxel-carboplatin (PC) or gemcitabine-cisplatin (GP)] and the second-line chemotherapy with docetaxel or pemetrexed. But as we know, if patients had no EGFR gene mutation, EGFR-TKI treatment is not effective. The overall survival is short and the objective response rate is low. As for EGFR gene wild type patients with good performance status, besides EGFR-TKI treatment, other first generation cytotoxic drugs i.e. vinorelbine or ifosfamide maybe an alternative treatment. So the purpose of this clinical trial is to compare the effectiveness and safety of vinorelbine-ifosfamide with gefitinib in advanced or metastatic EGFR gene mutation negative NSCLC patients.
Detailed Description
Ifosfamide is a first generation cytotoxic drug to treat NSCLC. Phase Ⅱ studies demonstrated that single-agent ifosfamide administrated by various schedules produces response rates of 15-29%, with media survival times of 5-7 months. Ifosfamide has also been used in various combination regimens to treat NSCLC, including platinum based and non-platinum regimens. But in refractory NSCLC patients platinum and some third generation cytotoxic drugs have been used before. So in this study, ifosfamide is combined with vinorelbine. In previous study, Masters reported the objective response rate was 40% and the median survival duration was 50 weeks, with a 1-year survival rate of 48% with vinorelbine-ifosfamide regimen [Vinorelbine 15 mg/m2 on days 1-3, and ifosfamide 2.0g/m2 on days 1-3 with granulocyte-colony stimulating factor (G-CSF) support]. The dose limiting toxicity (DLT) of this regimen is myelosuppression. In our experience, the regimen of vinorelbine 25mg/m2 d1, d8 and ifosfamide 1.25g/m2 d1-d3 with Mesna uroprotection is safe in Chinese population and the objective response rate is about 7% (data not published).

Gefitinib is the first small molecule inhibitor that has directed activity towards EGFR and has shown appreciable response rates in phase Ⅱ trials of patients with previously treated advanced NSCLC. In the posterior analysis of Iressa Dose Evaluation in Advanced Lung Cancer (IDEAL) and IRESSA Survival Evaluation in Lung Cancer (ISEL) trials, the response rate with gefitinib ranges from 2.6% to 10% in wild-type EGFR gene NSCLC patients.
Criteria for eligibility
Healthy Volunteers: No
Maximum Age: 70 Years
Minimum Age: 18 Years
Gender: Both
Criteria: Inclusion Criteria:

- age range:18-70 years old

- life expectancy more than 12 weeks

- histologically or cytologically confirmed inoperable NSCLC (stage ⅢB/Ⅳ)

- ineligible for curative radiotherapy

- no prior radiotherapy for the target lesions

- Eastern Cooperative Oncology Group (ECOG) performance score of 0-2;

- prior treatments include first-line platinum doublet chemotherapy i.e. PC or GP and second-line chemotherapy with docetaxel or pemetrexed;

- No EGFR gene mutation detected by Scorpions-ARMS;

- at least one bidimensionally measurable or radiographically assessable lesion;

- adequate bone marrow reserve;

- adequate hepatic and renal function;

Exclusion Criteria:

- prior treatments including any of the following drugs:gefitinib,vinorelbine and ifosfamide;

- additional malignancies;

- uncontrolled systemic disease;

- any evidence of clinically active interstitial lung disease;

- newly diagnosed central nervous system (CNS) metastasis and not treated by radiotherapy or surgery;

- pregnancy or breast feeding phase;
Location
Department of Respiratory Medicine, Peking Union Medical College Hospital
Beijing, Beijing, China
Status: Recruiting
Contact: Mengzhao Wang, MD - 010-69155039 - mengzhaowang@sina.com
Start Date
December 2012
Completion Date
December 2017
Sponsors
Peking Union Medical College Hospital
Source
Peking Union Medical College Hospital
Record processing date
ClinicalTrials.gov processed this data on July 28, 2015
ClinicalTrials.gov page