This phase I trial finds out the best dose, possible benefits and/or side effects of papaverine when given together with chemoradiation intreating patients with stage II-III non-small cell lung cancer. Papaverine targets mitochondrial metabolism to decrease the cancer growth process. Giving papaverine with chemoradiation may work best to treat patients with non-small cell lung cancer.
PRIMARY OBJECTIVE: I. To determine the maximally tolerated dose of papaverine (PPV) in combination with chemoradiation (CRT)/radiation therapy (RT) in patients with unresectable locally advanced (LA) non-small cell lung cancer (NSCLC) or oligometastatic NSCLC. SECONDARY OBJECTIVES: I. To estimate the rates of primary tumor control, local control, time to local-regional progression, disease-free survival (DFS), and overall survival (OS). II. To assess whether blood oxygen level determination (BOLD) functional magnetic resonance imaging (MRI) studies can predict which patients may respond best to PPV + CRT/RT, and detect changes in oxygenation before and after PPV administration. III. To assess whether blood-based and tissue-based biomarkers can predict which patients may respond best to PPV + CRT. OUTLINE: This is a dose-escalation study of PPV. Patients receive PPV intravenously (IV) or subcutaneously (SC) over 30 minutes and patients receiving chemoradiation undergo 5 fractions of radiation therapy (RT) per week for 6 weeks or 5 fractions of hypofractionated RT per week for 3 weeks without chemotherapy. Patients undergoing chemoradiation receive paclitaxel IV and carboplatin IV once weekly (QW) over 1-6 weeks or pemetrexed IV followed by carboplatin IV every 3 weeks during radiation in the absence of disease progression or unacceptable toxicity. Patients with PD-L1 positive disease may also receive durvalumab after completing CRT as considered clinically appropriate by the treating medical oncologist. Patients also undergo positron emission tomography/computed tomography (PET/CT) or CT and brain magnetic resonance imaging (MRI) during screening, and blood sample collection, MRI and CT scans throughout the trial. After completion of the study treatment, patients are followed for 2 years at 1, 3, 6, 9, 12, 16, 20, and 24 months, then periodically for up to 5 years.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
28
Given IV
Given IV
Given IV
Given IV or SC
Undergo RT
Given IV
Undergo hypofractionated RT
Undergo MRI
Undergo PET/CT
Undergo PET/CT or CT
Undergo brain MRI
Undergo blood sample collection
City of Hope
Duarte, California, United States
RECRUITINGOhio State University Comprehensive Cancer Center
Columbus, Ohio, United States
RECRUITINGMaximally tolerated dose (MTD) of papaverine (PPV) in combination with chemoradiation treatment (CRT) or definitive hypofractionated radiation therapy
Will employ the Time-to-event Bayesian optimal interval design to find the MTD. Treatment-related toxicity will be assessed based on Common Terminology Criteria for Adverse Events version 5.0 criteria.
Time frame: 6 weeks
Primary tumor control rate
Defined as the absence of primary tumor failure. Will be calculated and 95% exact binomial confidence interval will be provided.
Time frame: At 12 and 24 months post-treatment
Local control rate
Defined as the absence of local failure, which is a combination of primary tumor and involved lobe failure. Will be calculated and 95% exact binomial confidence interval will be provided.
Time frame: At 12 and 24 months post-treatment
Time to local-regional progression
Will be summarized using Kaplan-Meier method.
Time frame: From entry on the study until the time of documented local-regional recurrence or death, assessed at 12 and 24 months post-treatment
Disease-free survival
Will be summarized using Kaplan-Meier method.
Time frame: From entry on the study until the time of any documented disease recurrence or death, assessed at 12 and 24 months post-treatment
Distant-metastasis-free survival
Will be summarized using Kaplan-Meier method.
Time frame: At 12 and 24 months post-treatment
Overall survival
Will be summarized using Kaplan-Meier method.
Time frame: From study entry until the time of death from any cause, assessed at 12 and 24 months post-treatment
Changes in magnetic resonance imaging (MRI) blood oxygen level dependent (BOLD) response on MRI
Images pre and post PPV will be analyzed for stability of baseline and treatment signals. Percent BOLD change will be determined for maximal and overall signal changes. Comparisons between the distributions of pre and post PPV will be valuated using Earth Mover's Distance.
Time frame: Baseline up to 24 months
Changes in blood-based biomarkers related to predict patients response to PPV + CRT
Will acquire measurements of circulating serum microRNAs that can indicate tumor hypoxia or response to therapeutic intervention, and alterations in immune cell subsets that are suggestive of immune system activation or suppression with the experimental therapy
Time frame: Baseline up to 24 months
Changes in tissue-based biomarkers related to predict patients response to PPV + CRT
When biopsy tissue is available, will acquire gene expression profiles by Affymetrix gene chip for indications of tumor hypoxia or response to therapeutic intervention, and correlating tumor mutations in genes involved in the anti-oxidant response pathway with outcomes.
Time frame: Baseline up to 24 months
The Ohio State University Comprehensive Cancer Center
CONTACT
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