This randomized phase I trial is studying the side effects and the best dose of selumetinib when given together with paclitaxel as a second line therapy in treating patients with stage IIIB-IV non-small cell lung cancer (NSCLC). Selumetinib may stop or slow the growth of tumor cells by blocking a protein called mitogen-activated protein kinase (MEK) that is needed for cell growth. Drugs used in chemotherapy, such as paclitaxel, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving selumetinib together with paclitaxel may kill more tumor cells.
PRIMARY OBJECTIVE: I. To determine the safety and tolerability of three pre-planned arms of continuous, intermittent, and pulsatile selumetinib with paclitaxel as second-line treatment in patients with stage IIIB or IV NSCLC. SECONDARY OBJECTIVE: I. To determine the preliminary clinical response of continuous, intermittent, and pulsatile selumetinib with paclitaxel as second-line treatment in patients with stage IIIB or IV NSCLC. EXPLORATORY OBJECTIVES: II. To determine progression-free survival (PFS) and overall survival (OS) in patients treated with selumetinib/paclitaxel. II. To assess correlations between cell-free deoxyribonucleic acid (DNA) (cfDNA) molecular features from blood and molecular features and pathways from the biopsy samples, and use this as a surrogate measure of tumor response and duration of response as evaluated in the primary and secondary objectives. OUTLINE: This is a dose-finding study of selumetinib. The goal is to find out what dose and dosing schedule is the most effective in this population. Patients are randomized to 1 of 3 treatment arms. ARM I: Patients receive selumetinib orally (PO) twice daily (BID) on days 1-21 and paclitaxel intravenously (IV) over a fixed rate on days 1 and 8. ARM II: Patients receive selumetinib PO BID on days 1-5, 8-12, and 15-19 and paclitaxel as in Arm I. ARM III: Patients receive selumetinib PO BID on days 1-3, 8-10, and 15-17 and paclitaxel as in Arm I. In all three arms, treatment repeats every 21 days for 6 courses in the absence of disease progression or unacceptable toxicity. Patients experiencing clinical benefit from study treatment may continue treatment based on the principal investigator (PI) approval on a patient-by-patient basis. After completion of study treatment, patients are followed up at 30 days, every 8 weeks for 12 months, and then every 3 months thereafter.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
23
OHSU Knight Cancer Institute
Portland, Oregon, United States
Incidence of grade 3 or higher treatment-related adverse event (AE) using the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 4.0
Treatment arms will be summarized reporting the number of patients treated; the number who experience grade 3 or higher treatment-related AE. In addition, number of treatment cycles received will be summarized using descriptive statistics (median and range) by treatment arm. Comprehensive safety data on all toxicities will be tabulated by type, grade, duration, attribution to treatment, and treatment arm. A patient level summary by worst grade toxicity will be included. Laboratory data and concomitant medications associated with episodes of toxicity will be summarized as needed.
Time frame: Up to 30 days post-treatment
Proportion of patients with treatment-related dose limiting toxicities (DLT) using the National Cancer Institute (NCI)-Common Terminology Criteria for Adverse Events (CTCAE) version 4.0
Treatment arms will be summarized reporting the number of patients treated; the number who experience DLT; the number of patients who discontinue therapy, and the reasons for discontinuation. In addition, number of treatment cycles received will be summarized using descriptive statistics (median and range) by treatment arm. Comprehensive safety data on all toxicities will be tabulated by type, grade, duration, attribution to treatment, and treatment arm. A patient level summary by worst grade toxicity will be included.
Time frame: 21 days
Proportion of patients with treatment-related serious adverse events (SAEs) using the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 4.0
Treatment arms will be summarized reporting the number of patients treated; the number who experience SAEs. In addition, number of treatment cycles received will be summarized using descriptive statistics (median and range) by treatment arm. Comprehensive safety data on all toxicities will be tabulated by type, grade, duration, attribution to treatment, and treatment arm. A patient level summary by worst grade toxicity will be included. Laboratory data and concomitant medications associated with episodes of toxicity will be summarized as needed.
Time frame: Up to 30 days post-treatment
Best response complete response (CR), partial response (PR), stable disease (SD), or progressive disease (PD) using Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1
Time frame: Up to 4 years
Disease control rate (DCR)
DCR will be calculated as the proportion/percentage of patients with best overall response of CR, PR, or SD. Corresponding 95% confidence intervals, calculated by the binomial method, will be reported. In addition, patients in each response category (CR, PR, SD) will be summarized by descriptive statistics (median and range) with respect to time to onset of response and duration of response.
Time frame: Up to 4 years
Median overall survival (OS)
The Kaplan-Meier method will be used to estimate OS per treatment arm.
Time frame: From randomization to death or date of censoring, assessed at 6 months
Median overall survival (OS)
The Kaplan-Meier method will be used to estimate OS per treatment arm.
Time frame: From randomization to death or date of censoring, assessed at 12 months
Median progression-free survival (PFS) using Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1
The Kaplan-Meier method will be used to estimate PFS per treatment arm.
Time frame: From randomization until documented disease progression or death (by any cause, in the absence of progression), assessed at 6 months
Median progression-free survival (PFS) using Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1
The Kaplan-Meier method will be used to estimate PFS per treatment arm.
Time frame: From randomization until documented disease progression or death (by any cause, in the absence of progression), assessed at 12 months
Objective response rate (ORR)
ORR will be estimated for the three pre-planned arms of selumetinib/paclitaxel. ORR will be calculated as the proportion/percentage of patients with best overall response of CR or PR.
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Time frame: Up to 4 years
Overall survival (OS)
The Kaplan-Meier method will be used to estimate OS per treatment arm.
Time frame: From randomization to death or date of censoring, assessed up to 4 years post-treatment
Progression free survival (PFS) using Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1
The Kaplan-Meier method will be used to estimate PFS per treatment arm.
Time frame: From randomization until documented disease progression or death (by any cause, in the absence of progression), assessed up to 4 years