Phase 2 Study of AZD2171 (NSC 732208) in Combination With Pemetrexed in Relapsed Non-Small Cell Lung Cancer (NOS: 10029514)
Inclusion Criteria:
- Histologically or cytologically confirmed non-small cell lung cancer
- Measurable disease, defined as >= 1 unidimensionally measurable lesion >= 20 mm by
conventional techniques or >= 10 mm by spiral CT scan
- Lesions in a previously irradiated area are considered measurable provided there has
been an increase of >= 10 mm since completion of radiotherapy
- Received 1-2 prior regimens, including 1 doublet chemotherapy regimen, AND meets 1 of
the following criteria:
- No prior bevacizumab (cohort A)
- Patients with squamous cell carcinoma, treated and controlled brain metastases,
or history of hemoptysis allowed
- Received 1-2 prior regimens*, including 1 doublet chemotherapy regimen, AND meets 1
of the following criteria:
- Previously treated with bevacizumab (cohort B)
- No discontinuation of bevacizumab for uncontrollable hypertension and/or
life-threatening bleeding
- Must have disease progression after prior bevacizumab (NOTE: *Prior adjuvant
therapy is considered 1 regimen if disease progression occurred within 1 year of
completion of therapy; if a regimen was discontinued within 2 courses for
allergic reaction or unacceptable drug-specific toxicity, that regimen dose not
count)
- No large pleural effusion or ascites unless drained
- No active brain metastases by brain MRI or CT scan within the past 4 weeks
- Patients with treated, controlled brain metastasis allowed provided they are
neurologically stable without seizures within the past 3 weeks
- ECOG performance status (PS) 0-2 OR Karnofsky PS 60-100%
- Absolute neutrophil count >= 1,500/mm^3
- Platelet count >= 100,000/mm^3
- WBC >= 3,000/mm^3
- Bilirubin =< 1.5 times upper limit of normal (ULN)
- AST and ALT =< 2.5 times ULN (< 5 times ULN if liver metastases present)
- Creatinine normal OR creatinine clearance >= 60 mL/min
- Urine protein =< 1+ on 2 consecutive dipsticks taken >= 1 week apart
- No significant hemorrhage (i.e., > 30 mL in 1 episode) within the past 3 months
- No significant hemoptysis (i.e., > 5 mL fresh blood in 1 episode) within the past 4
weeks
- No active gastrointestinal disease that may affect the ability of the patient to
absorb AZD2171
- No history of allergic reactions attributed to compounds of similar chemical or
biologic composition to AZD2171 or pemetrexed disodium
- No other malignancies within the past 5 years except adequately treated basal cell or
squamous cell skin cancer or carcinoma in situ
- No uncontrolled intercurrent illness including, but not limited to, any of the
following:
- Ongoing or active infection
- Symptomatic congestive heart failure
- Unstable angina pectoris
- Cardiac arrhythmia
- Psychiatric illness or social situation that would preclude study compliance
- No New York Heart Association class III or IV heart disease
- Mean QTc < 470 msec by ECG
- No history of familial long QT syndrome
- Fertile patients must use effective contraception
- No resting blood pressure (BP) consistently > 140/90 mm Hg; Patients whose BP is
controlled after starting, adjusting, or increasing medication allowed
- LVEF normal by MUGA or echocardiogram for patients at increased risk for left
ventricular dysfunction, as evidenced by any of the following:
- Prior treatment with anthracyclines
- New York Heart Association class III or IV heart disease or controlled class II
disease
- Prior central thoracic radiotherapy, including radiotherapy to the heart
- Myocardial infarction within the past 12 months
- At least 4 weeks since prior definitive chest radiotherapy (> 60 Gy) and recovered
- At least 3 months since prior craniotomy for resection of brain metastasis
- At least 3 weeks since prior radiotherapy for brain metastases
- At least 4 weeks since prior chemotherapy (6 weeks for nitrosoureas or mitomycin C)
and recovered
- At least 2 weeks since prior palliative radiotherapy
- At least 2 weeks since prior surgery (excluding the placement of vascular access or
drainage of pleural effusion or ascites) and recovered
- No inability or unwillingness to take folic acid, cyanocobalamin (vitamin B12), or
dexamethasone
- No prior pemetrexed disodium
- At least 5 half-lives since prior and no concurrent drugs or biologics with
proarrythmic potential including:
- Amiodarone hydrochloride
- Arsenic trioxide
- Bepridil
- Chloroquine
- Chlorpromazine
- Cisapride
- Clarithromycin
- Disopyramide
- Dofetilide
- Domperidone
- Droperidol
- Erythromycin
- Halofantrine
- Haloperidol
- Ibutilide
- Mesoridazine
- Methadone
- Pentamidine
- Pimozide
- Procainamide
- Sotalol
- Sparfloxacin
- Thioridazine
- Not pregnant or nursing
- More than 30 days since prior investigational agents and recovered
- No aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) for 2 days before,
during, and for 2 days after pemetrexed disodium administration: Low-dose aspirin (≤
325 mg/day) for vascular disorders allowed
- No long-acting NSAIDs (e.g., naproxen, piroxicam, diflunisal, nabumetone, or
celecoxib) for 5 days before, during, and for 2 days after pemetrexed disodium
- No concurrent combination antiretroviral therapy for HIV-positive patients
- No other concurrent anticancer agents or therapies
- No other concurrent investigational agents
- Life expectancy > 12 weeks
- No concurrent medications that can markedly affect renal function (e.g., vancomycin
or amphotericin)
- Negative pregnancy test
- Relapsed disease