RATIONALE: Radiation therapy uses high-energy x-rays to kill tumor cells. Gefitinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy, such as temozolomide, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Giving radiation therapy together with either gefitinib or temozolomide may kill more tumor cells. PURPOSE: This randomized phase II trial is studying how well giving radiation therapy together with either gefitinib or temozolomide works in treating patients with non-small cell lung cancer and brain metastases.
OBJECTIVES: Primary * Compare the efficacy of whole-brain radiotherapy combined with either gefitinib or temozolomide, in terms of overall survival, in patients with non-small cell lung cancer and brain metastases. Secondary * Compare the tolerability and toxicity of these regimens in these patients. * Compare the time to neurological disease progression, time to extracranial disease progression, and time to overall disease progression, in patients treated with these regimens. * Compare adverse events in patients treated with these regimens. * Compare cognitive function and quality of life of patients treated with these regimens. OUTLINE: This is a randomized, open-label, parallel-group, multicenter study. Patients are stratified according to extracranial disease (yes vs no), number of brain metastases (1-3 vs ≥ 4), prior chemotherapy (yes vs no), WHO performance status (0-1 vs 2), and participating center. Patients are randomized to 1 of 2 treatment arms. * Arm I: Patients undergo whole-brain radiotherapy (WBRT) once daily on days 1-5 and 8-12 and receive oral gefitinib once daily on days 1-28. Gefitinib treatment repeats every 28 days in the absence of disease progression or unacceptable toxicity. * Arm II: Patients undergo WBRT as in arm I and receive oral temozolomide once daily on days 1-21. Temozolomide treatment repeats every 28 days in the absence of disease progression or unacceptable toxicity. Quality of life is assessed at baseline and on day 1 of courses 2, 3, and 5. After completion of study therapy, patients are followed every 3 months. PROJECTED ACCRUAL: A total of 30-86 patients (15-43 per treatment arm) will be accrued for this study within 3 years.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
59
Once daily during days 1-28
Once daily on days 1-21
Whole brain radiotherapy
Oncology Institute of Southern Switzerland
Bellinzona, Switzerland
Kantonsspital Graubuenden
Chur, Switzerland
Centre Hospitalier Universitaire Vaudois
Lausanne, Switzerland
Overall survival
Time frame: life-long
Time to progression
Time frame: 28 days
Time to neurological progression
Time frame: 28 days
Time to extracranial disease progression
Time frame: 28 days
Adverse events as measured at completion of study treatment
Time frame: 28 days
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