RATIONALE: Cilengitide may stop the growth of brain metastases by blocking blood flow to the tumor. Radiation therapy uses high energy X-rays to kill tumor cells. Giving cilengitide together with radiation therapy may kill more tumor cells. PURPOSE: This phase I trial is studying the side effects and best dose of cilengitide when given together with whole-brain radiation therapy in treating patients with brain metastases from lung cancer.
OBJECTIVES: * Primary * To assess the safety and tolerability of daily cilengitide by determining its dose-limiting toxicity and maximum-tolerated dose when combined with concomitant fractionated whole-brain radiation therapy in patients with brain metastases from lung cancer. * Secondary * To collect evidence of the best overall response rate, overall survival, brain-specific progression-free survival, and tumor-specific progression-free survival of these patients. * To collect evidence of changes in functional MRI imaging studies at 6 and 12 weeks after initiation of therapy. * To collect evidence of early response by functional MRI (ASL technique) on days 1, 4, and 12, immediately before and after the administration of cilengitide. * To collect evidence of changes in neurological and neurocognitive function tests at 6 and 12 weeks after initiation of therapy. * To further evaluate the safety and toxicity of the combination of cilengitide and whole-brain radiation therapy. * To further evaluate the pharmacokinetics of cilengitide administered daily. OUTLINE: Patients receive oral cilengitide once daily and undergo whole-brain radiotherapy on the same days. Treatment continues for 2 weeks in the absence of disease progression or unacceptable toxicity. Patients undergo blood sample collection on days 1, 4, 5, and 12 for pharmacokinetic studies. After completion of study treatment, patients are followed for 10 weeks.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
University Medical Center, Department of Surgery
Mannheim, Germany
Dose-limiting toxicity
(i) Any grade III-IV non-hematological toxicity as defined by CTCAE, version 3.0, with the exclusion ofalopecia, nausea, vomiting, and fever that can be rapidly contolled with appropriate measures; (ii) absolute neutrophil count (ANC)\<0.5x10'/L lasting for \>7days; (iii) febrile neutropenia defined as ANC \<1.0x10'/L and fever \>38.5°C; (iv) platelets \<25x10'/L or thrombocytopenic bleeding requiring transfusion; and (v) severe hypotension requiring dopamine administration.
Time frame: 12 days
Maximum-tolerated dose
5 planned steps to be tested: 100, 250, 500, 750, to 1000mg; the highest dose at which one or no DLT will have been observed among 6 patients
Time frame: 12 days
Overall response rate
Any response to treatment
Time frame: 12 weeks
Overall survival
Death as event, Kaplan-Meier (KM)
Time frame: 1 year
Brain-specific progression-free survival (PFS)
Every recurrence within the brain or death is an event, Kaplan-Meier (KM)
Time frame: 1 year
Tumor-specific PFS
Every tumor related event or death will be counted, Kaplan-Meier (KM)
Time frame: 1 year
Changes in functional MRI imaging (time to peak) at 6 and 12 weeks
time-to-peak measurements
Time frame: 12 weeks
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Changes in functional MRI imaging (blood flow) at 6 and 12 weeks
blood flow measurements
Time frame: 12 weeks
Changes in functional MRI imaging (blood volume changes) at 6 and 12 weeks
blood volume changes during functional MRI
Time frame: 12 weeks
Evidence of early response by functional MRI on days 1, 4, and 12
(ASL technique) on day 1,4 and 12, immediately before and after the administration of cilengitide.
Time frame: 12 days
Changes of neurocognitive function tests (intelligence) at 6 and 12 weeks
Intelligence was measured with a multiple-choice test of vocabulary knowledge.
Time frame: 12 weeks
Changes of neurocognitive function tests (memory figures) at 6 and 12 weeks
Memory was tested by aims of "Medical College of Georgia Complex Figures"
Time frame: 12 weeks
Changes of neurocognitive function tests (memory verbal) at 6 and 12 weeks
Memory was tested by aims of "Rea Auditory Verbal Learning Test - German Version"
Time frame: 12 weeks
Changes of neurocognitive function tests (perception) at 6 and 12 weeks
Perception was assessed by the "Digit Symbol Substitution Test"
Time frame: 12 weeks
Changes of neurocognitive function tests (attention/alertness) at 6 and 12 weeks
Attention was tested by "Alertness"
Time frame: 12 weeks
Changes of neurocognitive function tests (attention) at 6 and 12 weeks
Attention was tested by "Divided Attention"
Time frame: 12 weeks
Changes of neurocognitive function tests (attention speaking) at 6 and 12 weeks
Attention was tested by "Go,A.lo-Go".
Time frame: 12 weeks
Fatigue at 6 and 12 weeks
"Functional Assessment of Cancer Therapy - Fatigue Subscale" measured in points (range 0-52)
Time frame: 12 weeks
Anxiety/depression at 6 and 12 weeks
"Hospital Anxiety and Depression Scale - German Version"
Time frame: 12 weeks
Activities of daily living (Barthel) at 6 and 12 weeks
"Barthel Activities of Daily Living Index" measured in points (range 0-100)
Time frame: 12 weeks
Activities of daily living (instrumental) at 6 and 12 weeks
"lnstrumental Activities of Daily Living Scale" measured in points (range 0-8)
Time frame: 12 weeks