This study is being carried out to see if a new drug called Apatorsen in combination with standard gemcitabine/carboplatin chemotherapy is effective in treating squamous cell lung cancer. This study is part of a research project for collecting information about the effectiveness and safety of Apatorsen when used with gemcitabine/carboplatin chemotherapy. The main purpose of this study is to see if Apatorsen, when combined with gemcitabine/carboplatin, is an effective treatment for squamous cell lung cancer. Recent research has found that a protein called Hsp27 can help cancer cells protect themselves against the effects of cancer treatments. Hsp27 is only found in some lung cancers but when it is present, cancer drugs might not work as well as they would without Hsp27 being present. Blocking the action of Hsp27 or removing Hsp27 from cancer cells with Apatorsen may slow down or stop the cancer growing. This study will therefore look at the relationship between the Hsp27 levels in tumour and blood and the effect of the treatment. The development of Apatorsen is intended to provide a new treatment option for patients with cancer. Apatorsen may also make the cancer more sensitive to gemcitabine and carboplatin and so make this chemotherapy treatment more effective.
This is an open-label, multicentre, 2-arm randomised phase II trial of gemcitabine/carboplatin + Apatorsen (OGX-427) versus gemcitabine/carboplatin alone in patients with previously untreated advanced squamous cell lung cancers. Patients will be randomised (1:1) to one of the two treatment arms: * Gemcitabine/carboplatin * Gemcitabine/carboplatin + Apatorsen (OGX-427) Randomisation will be stratified by the following criteria: * Stage (IIIB versus IV versus recurrent disease) * Performance status (0 or 1 versus 2) Gemcitabine/carboplatin chemotherapy will be continued for 4-6 cycles unless there is evidence of unacceptable toxicity, disease progression, or if the patient requests that study treatment be discontinued or to be withdrawn from the study. If chemotherapy is discontinued prior to disease progression, patients in the combination arm should be continued on Apatorsen (OGX-427) single agent therapy until disease progression unless there is evidence of unacceptable toxicity, patient withdrawal of consent or termination of the study, whichever occurs first. All patients will be followed for disease progression. Tumour evaluations will be performed before the initiation of treatment and every 6 weeks during and after completion of chemotherapy. Once disease progression is documented, patients will enter a Survival Follow-up Period during which data will be collected every two months regarding further cancer therapy, secondary malignancy and survival status. The study will also assess the relationship between the anticipated anti-tumour activity of the treatment regimen and biological characteristics of patients' tumours at baseline.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
140
Apatorsen (OGX-427) is a second generation antisense oligonucleotide designed to bind to Hsp27 mRNA
Gemcitabine is an anti-cancer ("antineoplastic" or "cytotoxic") chemotherapy drug. Gemcitabine is classified as an antimetabolite
Carboplatin is an anticancer drug ("antineoplastic" or "cytotoxic") chemotherapy drug. Carboplatin is classified as an "alkylating agent."
Royal Cornwall Hospitals NHS Trust
Truro, Cornwall, United Kingdom
Medway NHS Foundation Trust
Gillingham, Kent, United Kingdom
Heart of England NHS Foundation Trust
Birmingham, United Kingdom
University Hospitals Bristol NHS Foundation Trust
Bristol, United Kingdom
Velindre Cancer Centre
Cardiff, United Kingdom
Colchester Hospital University NHs Foundation Trust
Colchester, United Kingdom
Betsi Cadwaladr University Health Board
Denbighshire, United Kingdom
NHS Tayside
Dundee, United Kingdom
Royal Surrey County Hospital NHS Foundation Trust
Guildford, United Kingdom
NHS Highland
Inverness, United Kingdom
...and 10 more locations
Progression-Free Survival as measured by investigator-assessed (using RECIST 1.1) progression-free survival
Progression-free survival, defined as the time from the date of randomisation to the date of first documented tumour progression based on investigator assessment (using RECIST 1.1) or death from any cause, whichever occurs first.
Time frame: Date of patient randomisation to the date of first documented tumour progression (estimated 7.5 months) or death
Clinical Activity as measured by response rate (RECIST 1.1), change in tumour size, disease control rate, and duration of response of gemcitabine/carboplatin + Apatorsen relative to gemcitabine/carboplatin alone
Assess the clinical activity, as measured by response rate (RECIST 1.1), change in tumour size, disease control rate, and duration of response of gemcitabine/carboplatin + Apatorsen (OGX-427) relative to gemcitabine/carboplatin alone
Time frame: At 12 weeks and 24 weeks post-randomisation until disease progression (estimated 7.5 months)
Overall survival benefit of gemcitabine/carboplatin + Apatorsen relative to gemcitabine/carboplatin alone
Estimate the overall survival benefit of gemcitabine/carboplatin + Apatorsen (OGX-427) relative to gemcitabine/carboplatin alone
Time frame: Date of randomisation to date of death (expected average 12 months)
Clinical benefit as measured by investigator assessment using RECIST 1.1
Estimate the clinical benefit of gemcitabine/carboplatin + Apatorsen (OGX-427) relative to gemcitabine/carboplatin alone, as measured by investigator-assessed PFS rate at 12 and 24 weeks
Time frame: At 12 and 24 weeks post-randomisation
Drug exposure measured as average dose per week
Evaluate drug exposure of gemcitabine/carboplatin + Apatorsen (OGX-427). Exposure is defined as average gemcitabine/carboplatin + Apatorsen (OGX-427) dose per week over whole treatment period. Gemcitabine/carboplatin chemotherapy will be continued for 6 cycles (each cycle is 21 days) unless there is evidence of unacceptable toxicity, disease progression, or if the patient requests that study treatment be discontinued or to be withdrawn from the study. If chemotherapy is discontinued prior to disease progression, patients in the combination arm should be continued on Apatorsen (OGX-427) single agent therapy until disease progression unless there is evidence of unacceptable toxicity, patient withdrawal of consent or termination of the study, whichever occurs first.
Time frame: 4-6 cycles of treatment (12-18 weeks) and for apatorsen arm until disease progression (estimated 7.5 months)
Compare the differences in health-related Quality of Life (HRQL) and symptoms for patients by treatment assignment as measured by the Functional Assessment of Cancer Therapy-Lung (FACT-L) scale, and the Euro-QOL 5D (EQ-5D)
Compare the differences in health-related quality of life (HRQL) and symptoms for patients by treatment assignment
Time frame: Baseline, once every 3 weeks for 18 weeks and 4 weeks after last dose (estimated 8.8 months)
Establish the safety and tolerability of gemcitabine/carboplatin + Apatorsen relative to gemcitabine/carboplatin alone
Establish the safety and tolerability of gemcitabine/carboplatin + apatorsen (OGX-427) relative to gemcitabine/carboplatin alone. This will include: * Incidence of serious adverse events * Incidence of grade 3 or higher adverse events (CTCAE, version 4.0) * Incidence of all adverse events of all grades * Incidence of infusion reactions and infusion-related adverse events * Adverse events leading to discontinuation of the study medication * Incidence of Grade 3 and 4 clinical laboratory results following study drug administration (CTCAE, version 4.0.3)
Time frame: 3 weeks before treatment to 4 weeks after last dose (estimated 8.5 months)
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