Return to List

Study Summary
No. 2005-0517:.......Lung......Roy S. Herbst......Thoracic and Head and Neck Med
.
Study Summary Title
Study Summary
Number:
2005-0517
Study Title:A Phase III, Multicenter, Placebo-Controlled, Double-Blind, Randomized Clinical Trial To Evaluate The Efficacy Of Bevacizumab In Combination With Tarceva (Erlotinib) Compared With Tarceva Alone For Treatment Of Advanced Non-Small Cell Lung Cancer (NSCLC) After Failure Of Standard First-Line Chemotherapy
.
Physician New Patient Referral
Name:Roy S. HerbstPatients Call:800-392-1611 (in U.S.A.) 713-792-6161 (outside U.S.A.)
Dept:Thoracic and Head and Neck MedReferring MD
Call:
800-392-1611 (in U.S.A.) 713-792-6161 (outside U.S.A.)
Phone:713-792-6363
Contact us about clinical trials
.
General Information
Disease Group:LungSupported By:N/A
Phase of Study:Phase IIIReturn
Visit:
Week 3 (Day 21) Visit and Every 3 Weeks Thereafter
Treatment
Agents:
Bevacizumab
Tarceva
Home Care:na
Treatment Loc:Independent Multicenter Arrangements
Estimated
Length of Stay
in Houston:
na
Description/
Intervention:
The goal of this clinical research study is to compare the effectiveness of
using a combination of Tarceva (erlotinib) and bevacizumab to using erlotinib
alone in patients with NSCLC who have already been treated for advanced lung
cancer that is recurrent (the cancer has grown or spread) or resistant to
previous treatment.
.
Study Objectives / Outcomes
      Primary Objective

      The primary objective of this Phase III study was to evaluate the efficacy of combining bevacizumab with Tarceva (erlotinib) relative to Tarceva monotherapy in patients receiving second-line therapy for advanced NSCLC. Efficacy will be assessed by measuring overall survival.

      The addition of bevacizumab to erlotinib in the BETA lung study was not associated with an inprovement in overall survival. However, bevacizumab when combined with erlotinib improved progression free survival and objective response rate, demonstrating evidence of clinical activity.

      Secondary Objectives

      The secondary objectives of this Phase III study were as follows:

      To evaluate the safety of combining bevacizumab with Tarceva in patients with previously treated advanced NSCLC, including patients with squmaous cell carcinoma, patients with treated brain metastases, and patients receiving full-dose anticoagulation with low-molecular-weight heparin or fondaparinux.

      To evaluate the efficacy of combining bevacizumab with Tarceva relative to Tarceva monotherapy in patients with previously treated advanced NSCLC, as measured by PFS, objective response rate, and duration of response

      To evaluate the pharmacokinetic behavior of Tarceva and the combination of bevacizumab with
      Tarceva in a subset of patients with previously treated advanced NSCLC
To evaluate the association of survival, PFS, and treatment effect with markers of epidermal growth factor receptor (EGFR) expression, as measured by immunohistochemistry (IHC), EGFR gene copy number measured by fluorescence in situ hybridization (FISH), and other molecular markers of EGFR pathway activity in archival tissue samples

Note: The safety profile of patients who remain on protocol treatment at the enactment of amendment 5 will be evaluated to better characterize the long term safety of the bevacizumab/erlotinib combination.
.
Study Status Information
Study Activation / Registration Date:02/20/2006
IRB Review and Approval Date:09/21/2005
Study Type:Therapeutic
Recruitment Status:Terminated
Projected Accrual:650
.
Enrollment Eligibility
If you do not meet the enrollment eligibility, there may be other treatment options for you. Please Contact the Referral Office for more information.

Inclusion Criteria:1) Signed written informed consent

2) Cytologically or histologically confirmed NSCLC. Patients had to have histologically or cytologically confirmed NSCLC. Tumors of mixed histology were categorized by the predominant cell type, unless small cell elements are present, in which case the patient was not eligible for study participation. Cytologic or histologic elements have been established on metastatic tumor aspirates or biopsy.

3) Patients with squamous cell carcinoma were eligible provided that their disease is extrathoracic or that their intrathoracic disease consists of peripheral lesions only. A peripheral lesion was defined as a lesion (or lesions) in which the epicenter of the tumor was </= 2 cm from the costal or diaphragmatic pleura in a 3-dimensional orientation based on each lobe of the lung, and > 2 cm from the trachea, main, and lobar bronchi.

4) Squamous cell carcinoma patients were eligible for study participation irrespective of the proximity of their adenopathy to the costal or diaphragmatic pleura or major pathways. Patients with hilar adenopathy were eligible for study participation.

5) Patients with squamous cell carcinoma must have a copy of the screening computed tomography (CT) or magnetic resonance imaging (MRI) scans (either as copy films or digital images) reviewed by Genentech or its designee prior to randomization. Patients will not be randomized until Genentech or its designee provides confirmation of eligibility.

6) Patients with a history of brain metastases were eligible for study participation, as long as their brain metastases had been treated and they did not have an ongoing requirement for treatment with dexamethasone at screening. Treatment with WBRT (e.g., 3000 cGy over 2 weeks) and might include neurosurgery, or stereotactic radiosurgery. Radiotherapy and stereotactic radiosurgery had to be completed at least 4 weeks prior to Day 0. Neurosurgery had to be completed at least 24 weeks prior to Day 0, and brain biopsy had to be completed at least 12 weeks prior to Day 0.

7) Continuation from Inclusion Criteria #5: Participants with no evidence of current brain metastases were be eligible.

8) Clinical or radiographic progression during of after first-line chemotherapy or chemoradiotherapy for NSCLC. Patients receiving neo-adjuvant and adjuvant therapy for Stage I-IIIA disease prior to their first line regimen were eligible for study participation provided they had also received first-line therapy (for unresectable, metastatic disease)and had demonstrated progression during or after that first-line therapy.

9) Consent to provide archival tissue for analysis was required for participation in this study. Patients who consented to provide tissue but whose archival tissue was found to be inadequate (e.g., stained slides) remained eligible for study participation.

10) ECOG performance status of 0, 1, 2

11) Age >/=18 years

12) Use of an acceptable means of contraception for men and women of childbearing potential

13) INR no greater than 1.3 and an aPTT no greater than the upper limits of normal within 28 days prior to enrollment for patients not on low-molecular-weight hearin or fondaparinux. Patients on low-molecular-weight heparin or fondaparinux were not required to meet INR or aPTT limits.

Exclusion Criteria:1) Squamous cell carcinoma, except for patients with no intrathoracic disease or small peripheral lesions only A peripheral lung lesion was defined as any lesion meeting the following criteria: A lesion (or lesions) in which the epicenter of the tumor is </= 2 cm from the costal of diaphragmatic pleura in a 3-dimensional orientation based on each lobe of the lung, and > 2 cm from the trachea, main, and lobar bronchi.

2) Adenopathy was not considered when assessing the peripheral nature of a patient's squamous cell carcinoma. Patients were eligible for study participation irrespective of the proximity of their adenopathy to the costal or diaphragmatic pleura or major airways.

3) Prior treatment with an investigational or marketed inhibitor of the EGFR pathway or anti-angiogenesis agent. Angiogenesis inhibitors include (but are not limited to) bevacizumab, thalidomide, CP 547632, SU 11248, and PTK 787.

4) Systemic chemotherapy, radiotherapy, or investigational treatment within 28 days prior to randomization

5) Local palliative radiotherapy within 14 days prior to randomization or persistent adverse effects from radiotherapy that have not resolved to Grade 2 or less following completion of treatment

6) Whole brain radiotherapy or stereotactic radiosurgery for brain metastases within 4 weeks of Day 0

7) Neurosurgery for brain metastases within 24 weeks of Day 0.

8) Brain biopsy within 12 weeks of Day 0

9) Current use of dexamethasone for treatment associated with brain metastases

10) History of gross hemoptysis (defined as bright red blood of at least 1/2 teaspoon or 2.5 mL per episode) within 3 months prior to randomization unless definitively treated with surgery or radiation

11) History of any of the following within 6 months prior to day 0: serious systemic disease, including myocardial infarction, uncontrolled hypertension (systolic blood pressure > 150 mmHg or diastolic blood pressure > 100 mmHg taken per the JNC 7 guidelines [see http://www.nhlbi.nih.gov/guidelines/hypertension/jncintro.htm]), unstable angina, New York Heart Association (NYHA) Grade 2 or greater CHF, unstable symptomatic arrhythmia requiring medication (patients with chronic atrial arrhythmia, i.e., atrial fibrillation or paroxysmal supraventricular tachycardia are eligible)...continued in ex #12

12) Continuation from exclusion # 11: clinically significant peripheral vascular disease, abdominal fistula, gastrointestinal perforation, or intra-abdominal abscess. Patients with evidence of hypertension during study screening were to be evaluated for uncontrolled hypertension in accordance with the JNC guidelines.

13) Evidence of bleeding diathesis or coagulopathy or other serious or acute internal bleeding within 6 months prior to randomization

14) CNS bleeding; history or clinical evidence of CNS stroke (hemorrhagic or thrombotic) within the last 6 months

15) Progressive neurologic symptoms in patients with a history of brain metastases

16) Full-dose anticoagulation with warfarin: Patients who require full-dose anticoagulation may be treated with low-molecular-weight heparin or fondaparinux. Patients fully anticoagulated with warfarin during the study will be discontinued from bevacizumab/placebo.

17) Current, ongoing treatment with full-dose warfarin or its equivalent (i.e., unfractionated and/or low molecular weight heparin) In addition, patients who require treatment with full-dose anticoagulants for any reason during the course of the study will be discontinued from bevacizumab/placebo. Those patients remaining on Tarceva who require full-dose anticoagulation with warfarin will need continued close INR monitoring.

18) Chronic daily use of aspirin (> 325 mg/day) or other full-dose NSAIDS with anti-platelet activity. Treatment with other antiplatelet agents (e.g., dipyridamole, ticlopidine, clopidogrel, and /or cilostazol) was permitted.

19) In-patient surgical procedure, open biopsy, or significant traumatic injury within 28 days prior to randomization (placement of a central line is not considered surgery, and can be placed on the same day as study drug administration)

20) Minor surgical procedure, fine needle aspirations or core biopsy within 7 days prior to randomization

21) Anticipation of need for a major surgical procedure during the course of the study

22) Serious, non-healing wound, ulcer, or bone fracture

23) Inability to take oral medication or requirement for IV alimentation or total parenteral nutrition with lipids, or prior surgical procedures affecting absorption

24) Any of the following abnormal hematologic values (within 1 week prior to randomization) ANC </= 1000 cells/microliter Platelet count </= 100,000 cells/microliter Hemoglobin </= 9.0 g/dL INR >/= 1.5 x upper limit of normal (ULN)

25) Any of the following abnormal liver function tests (within 1 week prior to randomization) Serum bilirubin >/=1.5 x ULN Albumin </= 2.5 g/dL Serum ALT >/= 2 x ULN (unless clearly due to liver metastases, then 5 x ULN) Serum AST >/=2 x ULN (unless clearly due to liver metastases, then 5 x ULN)

26) Other baseline laboratory values Uncontrolled hypercalcemia (>/=11.5 mg/dL) Urinary protein to creatinine ratio >/= 1 (spot urine) or serum creatinine >/= 2.0 x ULN

27) Pregnancy or breast-feeding Because of the possible teratogenic effect, pregnant women and women who are currently breast-feeding may not participate in this study. All women of childbearing potential must have a negative pregnancy test within 1 week prior to randomization

28) Presence of another invasive cancer within 5 years prior to randomization, except for adequately treated basal or squamous cell skin cancer, or carcinoma in situ of the cervix

29) Evidence of confusion or disorientation, or history of major psychiatric illness that may impair the patient's understanding of the Informed Consent Form or their ability to comply with study requirements

.
Links
Registration Number: NCT00130728
Study Information on Clinical Trials Registry (clinicaltrials.gov)

Other Links:
.
Results


Return to Clinical Trials at M.D. Anderson Cancer Center