Brief Title: S1300 Pemetrexed Disodium With or Without Crizotinib in Treating Patients With Stage IV Non-Small Cell Lung Cancer That Has Progressed After Crizotinib
Official Title: S1300 A Randomized Phase II Trial of Crizotinib Plus Pemetrexed Versus Pemetrexed Monotherapy in ALK-Positive Non-squamous NSCLC Patients Who Have Progressed Systemically After Previous Clinical Benefit From Crizotinib Monotherapy
Status: TERMINATED
Status Verified Date: 2020-02
Last Known Status: None
Delayed Posting: No
If Stopped, Why?: science has moved forward and there is no intent to complete the study
Has Expanded Access: False
If Expanded Access, NCT#: N/A
Has Expanded Access, NCT# Status: N/A
Acronym: None
Brief Summary: This randomized phase II trial studies how well pemetrexed disodium with or without crizotinib works in treating patients with stage IV non-small cell lung cancer that has progressed after crizotinib Drugs used in chemotherapy such as pemetrexed disodium work in different ways to stop the growth of tumor cells either by killing the cells by stopping them from dividing or by stopping them from spreading Crizotinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth It is not yet known whether giving pemetrexed disodium is more effective with or without crizotinib in treating patients with non-small cell lung cancer that has progressed after crizotinib
Detailed Description: PRIMARY OBJECTIVES
I To evaluate the efficacy of the combination of crizotinib and pemetrexed pemetrexed disodium compared to pemetrexed monotherapy as measured by progression-free survival PFS in anaplastic lymphoma kinase ALK non-squamous non-small cell lung cancer NSCLC patients who achieved clinical benefit with crizotinib monotherapy and subsequently progressed systemically
SECONDARY OBJECTIVES
I To compare the response rate confirmed and unconfirmed complete and partial responses in patients randomized to receive pemetrexed monotherapy to historical data
II To assess overall survival in both arms III To evaluate the patterns of failure central nervous system CNS extra-CNS of the combination of crizotinib and pemetrexed and of pemetrexed monotherapy in ALK non-squamous NSCLC after progression on crizotinib
IV To evaluate the frequency and severity of toxicities resulting from the administration of crizotinib and pemetrexed compared to pemetrexed monotherapy
V To evaluate PFS and the response rate in patients treated with crizotinib following progression on the pemetrexed monotherapy arm
TERTIARY OBJECTIVES
I To compare progression-free survival PFS and response rates RR between ALK dominant and ALK non-dominant patients in the entire study population and within each treatment arm
II To evaluate if the magnitude of difference in these outcomes between ALK dominant and ALK non-dominant patients varies by treatment arm
III To assess blood biomarkers of sensitivity and resistance to crizotinib and pemetrexed in an exploratory manner The blood biomarkers include cell free circulating deoxyribonucleic acid DNA micro ribonucleic acid microRNA before treatment during treatment after 2 cycles and at treatment progression
IV To assess pharmacogenomic factors in peripheral blood that might affect the drug level and treatment outcomes in an exploratory manner
V To assess proteomicimmunologic parameters that might affect the treatment outcomes in an exploratory manner
VI To evaluate the frequency of individual mechanisms of resistance copy number gain CNG mutation alternate oncogene
VII To identify alternative driver mechanisms in ALK fluorescence in situ hybridization positive FISH otherwise unknown
OUTLINE Patients are randomized to 1 of 2 treatment arms
ARM I Patients receive crizotinib orally PO twice daily BID on days 1-21 and pemetrexed disodium intravenously IV over 10 minutes on day 1
ARM II Patients receive pemetrexed disodium IV over 10 minutes on day 1 Upon disease progression or symptomatic deterioration patients may crossover to Arm I
In both arms courses repeat every 21 days in the absence of disease progression or unacceptable toxicity
After completion of study treatment patients are followed up for 3 years