NSCLC patients often have cerebral metastasis : 10% at diagnosis and 40% during disease management. Neurosurgery is not indicated in the majority of cases because of presence of several lesions in the brain, failure of primary tumor control or presence of extra-cerebral metastasis. Cerebral metastasis lead to death in 30 to 50% of these cases. Management of these patients in this situation is based on supportive care and whole-brain radiotherapy. The place of chemotherapy for patients with good performance status was discussed for a long time and it is now admitted. However, the place of new drugs such as pemetrexed, which is currently used as a second line treatment for NSCLC, needs to be further studied. It is known that pemetrexed when added to cisplatin for treatment of NSCLC provides a similar effectiveness when compared to other drugs associations commonly used in this indication. In addition, Cisplatin with Pemetrexed probably present a better safety profile. The present study is based upon the hypothesis stipulating that the association cisplatin-pemetrexed will be at least as efficient as the others association currently used for treatment of NSCLC and will present a better safety profile. The primary objective of this study is overall response rate on brain metastasis according to RECIST criteria. Secondary judgment criterias are : Overall response rate, PFS after first-line CDDP plus pemetrexed, safety profile, quality of life, neurological symptoms, overall survival. The trial will enroll up to 45 patients in this single-arm two-stage sequential phase II study with the possibility of stopping the study early because of lack of efficacy.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
45
Alimta 500mg/m² IV 10 min infusion and Cisplatin 75mg/m² IV 60 min on day 1. Cycle will be repeated each 21 days.Folic acid orally 400µg should begin 5-7days prior to the first dose of pemetrexed and continuing daily until 3 weeks after the last dose of pemetrexed. Vitamin B12 will be administered as a 1000 mg intramuscular injection, approximately one week before Day 1 of cycle 1 and should repeat approximately every 9 weeks Dexamethasone, 4 mg or equivalent, should be taken orally twice per day on the day before, the day of, and the day after each dose of pemetrexed.WBRT will be administered with high energy photons systematically after cycle 6 or in case of stable disease (SD) after cycle 4 or progressive disease (PD) at any time. The dose will be 3Gy by fraction, 1 fraction per day, for 10 days.
Centre Hôspitalier du Pays d'Aix, Service des Maladies Respiratoires
Aix-en-Provence, France
CHU d'Angers, Service de Pneumologie
Angers, France
Médecine 4, C.H.G. de la Fontonne Antibes
Antibes, France
CHU brest, institut de cancérologie et d'hématologie
Brest, France
Centre François Baclesse
Caen, France
Centre Hospitalier René Dubos - Pontoise, Service d'Oncologie - Hématologie Clinique
Cergy-Pontoise, France
Centre Hospitalier, Service de Pneumologie
Charleville, France
CHI, Service de Pneumologie
Créteil, France
Pneumologie, Centre hôspitalier, DRAGUIGNAN
Draguignan, France
CH GAP
Gap, France
...and 15 more locations
Objective of this study is overall response rate on brain metastasis according to RECIST criteria.
Time frame: After cycles 2, 4 and 6 and every 6 weeks after study drug completion in absence of disease progression.
Overall response rate, PFS after first-line CDDP plus pemetrexed, safety profile, quality of life, neurological symptoms and overall survival.
Time frame: After cycles 2, 4 and 6 and every 6 weeks after study drug completion.
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