In this study, patients with small cell or non-small cell lung cancer will receive ADI-PEG 20, gemcitabine, and docetaxel after demonstrated progression on frontline therapy. In phase I of the study, up to 6 dose levels will be tested to find the recommended phase II dose (RP2D), after which patients enrolling to phase II will be treated at that dose level to assess efficacy. Although safety and tolerability has been previously determined in the sarcoma population, dose de-escalations of the chemotherapies in that patient population were required. Therefore, a phase I portion will be incorporated to determine the RP2D of the triplet in this population.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
31
-Given 60 minutes (+/- 15 minutes) prior to docetaxel
-Given over the course of 90 minutes (+/- 10 minutes)
-Given over the course of 60 minutes (+/- 10 minutes)
Northwestern University
Chicago, Illinois, United States
Washington University School of Medicine
St Louis, Missouri, United States
Inova Schar Cancer Institute
Fairfax, Virginia, United States
Recommended phase II dose (Phase I only)
-The maximum tolerated dose (MTD) is defined as the dose level immediately below the dose level at which 2 patients of a cohort (of 2 to 6 patients) experience dose-limiting toxicity during the first 4 weeks of treatment. Dose escalations will proceed until the MTD has been reached or until Dose Level 3, and this dose level will then be defined as the Recommended Phase 2 Dose (RP2D).
Time frame: Through the first 4 weeks of treatment for all Phase I enrolled participants (estimated to be 12 months and 4 weeks)
Treatment-related serious adverse event (SAE) rate (Phase I only)
-SAE: an adverse event or suspected adverse reaction is considered "serious" if, in the view of the investigator, it results in any of the following outcomes: * Death * A life-threatening adverse event * Inpatient hospitalization or prolongation of existing hospitalization * A persistent or significant incapacity or substantial disruption of the ability to conduct normal life functions * A congenital anomaly/birth defect * Any other important medical event that does not fit the criteria above but, based upon appropriate medical judgment, may jeopardize the subject and may require medical or surgical intervention to prevent one of the outcomes listed above
Time frame: From start of treatment through 30 days after completion of treatment (estimated to be 106 weeks)
Objective response rate (ORR) (Phase II only - compared between non-small cell lung and small cell lung)
* ORR = percentage of participants with complete response, partial response, or stable disease for 8 cycles * Complete response (CR): Disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to \<10 mm. Disappearance of all non-target lesions and normalization of tumor marker level. * Partial response (PR): At least a 30% decrease in the sum of the diameters of target lesions, taking as reference the baseline sum diameters. * Stable disease (SD): Neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, taking as reference the smallest sum diameters while on study.
Time frame: Through completion of treatment (estimated to be 102 weeks)
Progression-free survival (PFS) (Phase II only - compared between non-small cell lung and small cell lung)
* PFS is defined as the time from date of treatment initiation to disease progression or death from any cause, whichever occurs first. The patients alive, without progression, are censored at the last follow-up. * Progressive disease (PD): At least a 20% increase in the sum of the diameters of target lesions, taking as reference the smallest sum on study (this includes the baseline sum if that is the smallest on study). In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5 mm. Appearance of one or more new lesions and/or unequivocal progression of existing non-target lesions. Unequivocal progression should not normally trump target lesion status. It must be representative of overall disease status change, not a single lesion increase.
Time frame: Through completion of follow-up (estimated to be up to 362 weeks)
Overall survival (OS) (Phase II only - compared between non-small cell lung and small cell lung)
OS is defined as the time from the date of treatment initiation to the date of death, censored at the last follow-up otherwise.
Time frame: Through completion of follow-up (estimated to be up to 362 weeks)
Clinical benefit rate (CBR) (Phase II only - compared between non-small cell lung and small cell lung)
* CBR = the percentage of participants who have experienced complete response + partial response + stable disease. * Complete response (CR): Disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to \<10 mm. Disappearance of all non-target lesions and normalization of tumor marker level. * Partial response (PR): At least a 30% decrease in the sum of the diameters of target lesions, taking as reference the baseline sum diameters. * Stable Disease (SD): Neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, taking as reference the smallest sum diameters while on study. Persistence of one or more non-target lesion(s) and/or maintenance of tumor marker level above the normal limits.
Time frame: Through completion of treatment (estimated to be 102 weeks)
Cancer-related mortality rate (Phase II only - compared between non-small cell lung and small cell lung)
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Time frame: Through completion of follow-up (estimated to be up to 362 weeks)