The purpose of this study is to study if the addition of the green tea extract, Polyphenon E, to Erlotinib is safe and if it has potential to improve outcomes in second line therapy for Advanced Stage IIIb/IV Non-small cell lung cancer.
To evaluate the short term effects of Polyphenon E administered alone and in combination with erlotinib to patients with advanced Stage IIIB or IV Non Small Cell Lung Cancer (NSCLC) that has progressed after first line chemotherapy. We will do a Phase I dose escalation study with Polyphenon E and a fixed dose of erlotinib to evaluate for any significant adverse events related to the combination. Once the maximum tolerated dose (MTD) of Polyphenon E has been established the Phase II trial will be embarked upon using this dose in combination with erlotinib. In both the Phase I and Phase II parts the agents will administered until time of progression or unacceptable side effects occur. The primary end point of the Phase I part is establishing the safety, tolerability and MTD of Polyphenon E in combination with erlotinib given at 150mg per day. The Primary endpoint of the Phase II part that will be studied is Response rate (RR) to the combination. Progression free survival (PFS), Overall Survival (OS) and the safety and tolerability of Polyphenon E in addition to erlotinib in this subject population and setting will be assessed as secondary objectives. Changes in serum markers related to progression of cancer will also be studied as part of the Phase I and phase II study. The effect of Polyphenon E with or without erlotinib on the serum levels of circulating c-met RNA, Interleukin-8 (Il-8), Hepatocyte Growth Factor (HGF) and Vascular Endothelial Growth Factor (VEGF) will be studied as secondary objectives. Epidermal Growth Factor Receptor (EGFR) expression of the initial tumor tissue and testing for EGFR mutations in the tumor tissue and serum DNA and evaluation of "KIRSTEN RAT SARCOMA VIRAL ONCOGENE HOMOLOG" (KRAS) mutations with correlation of these results with treatment outcome will also be undertaken as secondary objectives in both the Phase I and II parts. 1.1 Determine the safety, tolerability and MTD of Polyphenon E given in combination with erlotinib. Polyphenon E dose-escalation from 200, 400 and 800mg/day will be performed to evaluate for the MTD when used together with erlotinib 150mg/d. 1.2 Determine the effects of Polyphenon E in addition to erlotinib on response rate, progression free survival and overall survival 1.3 Determine the effects of Polyphenon E on circulating serum C-met messenger RNA 1.4 Determine the effects of Polyphenon E on serum HGF levels 1.5 Determine the effects of Polyphenon E on serum Il-8 levels 1.6 Determine the effects of Polyphenon E on serum VEGF levels 1.7 Determine the safety and tolerability of Polyphenon E in addition to erlotinib in this subject population 1.8 Determine the possible correlation between EGFR expression on original tumor tissue, EGFR mutations in tumor tissue and serum DNA and the presence of KRAS mutations with the treatment response and outcome. This study was intended to be a Phase I/II study. This study never moved into the Phase II portion of the study. The sponsor stopped supplying Polyphenon E and there was not enough of a supply in-house to continue with Phase II.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
11
Patients will be assigned to 3 sequential cohorts of three different dose levels of Polyphenon E (providing 200, 400 and 800mg of Polyphenon E given once daily) in a step-wise manner.
All patients will also receive Erlotinib 150mg po/day from Day 1.
LSUHSC-Shreveport, Feist-Weiller Cancer Center
Shreveport, Louisiana, United States
Phase 1: Number of Participants with Adverse Events.
Toxicity evaluation of all adverse events monitored by physical exam, weight, vital signs, Complete Blood Count (CBC), Complete Metabolic Panel (CMP), coagulation panel and Computed Tomography (CT) scans of the chest, abdomen and pelvis, CT/Magnetic Resonance Imaging (MRI) of the head.
Time frame: At Screening and every week for first 4 weeks and then week 6, 8 and then every 4 weeks in Phase I study. Liver function tests will be monitored at least every 4 weeks as applicable. The patients will be followed up to 2 years on average.
Phase 1: Maximum Tolerated Dose
Dose-Limiting Toxicity (DLT) is defined as two or more events with grade 3 toxicity or a single event with grade 4-5 toxicity possibly or probably related to the study medications at a specific dose of Polyphenon E.
Time frame: Day 1 of Phase I until progression, death or intolerable side effects would occur. The patients will be followed up to 2 years on average.
Phase 2: Response Rate
Response Rate defined as Complete (CR) + Partial Response (PR) using RECIST criteria. Complete response (CR): Complete disappearance of all measurable and non-measurable disease, no new lesions, no disease related symptoms, and normalization of markers and other abnormal lab values. All disease must be assessed using the same technique as baseline. Partial Response (PR): Applies only to patients with at least one measurable lesion. Greater than or equal to 30% decrease under baseline of the sum of longest diameters of all target measurable lesions. No unequivocal progression of non measurable disease. No new lesions. All target measurable lesions must be assessed using the same techniques as baseline.
Time frame: Start of Phase 2 to until progression, death or intolerable side effects occur. The patients will be followed up to 2 years on average.
Phase I: Response rate
Response Rate defined as Complete (CR) + Partial Response (PR) using RECIST criteria. Complete response (CR): Complete disappearance of all measurable and non-measurable disease, no new lesions, no disease related symptoms, and normalization of markers and other abnormal lab values. All disease must be assessed using the same technique as baseline. Partial Response (PR): Applies only to patients with at least one measurable lesion. Greater than or equal to 30% decrease under baseline of the sum of longest diameters of all target measurable lesions. No unequivocal progression of non measurable disease. No new lesions. All target measurable lesions must be assessed using the same techniques as baseline.
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Time frame: From registration until progression or intolerable side effects occur. The patients will be followed up to 2 years on average.
Phase 1: Progression Free Survival
Progression- Free Survival: From date of registration to date of first observation of progressive disease, death due to any cause or symptomatic deterioration.
Time frame: From registration until progression or intolerable side effects occur. The patients will be followed up to 2 years on average.
Phase 2: Progression Free Survival
From date of registration to date of first observation of progressive disease, death due to any cause or symptomatic deterioration.
Time frame: From registration until progression or intolerable side effects occur. The patients will be followed up to 2 years on average.
Phase 2: Overall Survival
Time from registration to death of any cause measured in months.
Time frame: From registration until progression or intolerable side effects occur. The patients will be followed up to 2 years on average.
Phase 2: Correlation between level of EGFR expression on the original tumor tissue and the presence of EGFR mutations in exons 18, 19 and 21 in serum DNA and original tumor tissue with the treatment response and outcome.
To analyze signaling pathway activity western blot analysis will be performed using antibodies that recognize serum interleukin-8 (IL-8), VEGF and HGF levels. The level of circulating C-met RNA will be measured using Real Time Polymerase Chain Reaction (RT-PCR).
Time frame: Pre-study until progression or intolerable side effects occur. The patients will be followed up to 2 years on average.
Phase 2: Correlation of KRAS mutations (in exons 2 and 3) in the original tumor tissue with treatment response and outcome.
Clinical assay for detecting mutations in KRAS (direct sequencing).
Time frame: Pre-study until progression or intolerable side effects occur. The patients will be followed up to 2 years on average.