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| ID | Type | Description | Link |
|---|---|---|---|
| 200412739 | Other Identifier | UC Davis | |
| H3E-US-X038 | Other Identifier | Eli Lilly |
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| Name | Class |
|---|---|
| Eli Lilly and Company | INDUSTRY |
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RATIONALE: Bortezomib and pemetrexed disodium may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Giving bortezomib together with pemetrexed disodium may kill more tumor cells.
PURPOSE: This phase I/II trial is studying the side effects and best dose of two different schedules of bortezomib when given together with pemetrexed disodium and to see how well they work in treating patients with advanced non-small cell lung cancer or other solid tumors.
OBJECTIVES:
Primary
Secondary
Tertiary
OUTLINE: This is a phase I, dose-escalation study of bortezomib followed by a phase II, open-label study.
Phase I: Patients will be accrued, in an alternating fashion, to 1 of 2 treatment groups.
In both groups, treatment repeats every 21 days in the absence of unacceptable toxicity or disease progression.
Cohorts of 3-6 patients per group receive escalating doses of bortezomib until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity.
Blood is drawn at baseline and prior to courses 2 and 3 for correlative and molecular studies.
Tumor tissue and blood samples from patients enrolled in the phase II portion of the study are examined for various biological markers. Immunohistochemistry is used to measure BCL-2 gene, BCL-xL gene, BAX gene, and p27. Reverse transcriptase-polymerase chain reaction is used to assay the expression of thymidylate synthase, folsyl-polyglutamate synthase, and reduced folate carrier. Levels of plasminogen-activator inhibitor 1 gene, vascular endothelial growth factor, and osteopontin are measured by immunoenzyme techniques. The nuclear expression of NF-kB and p27 in blood is compared before and after study treatment by flow cytometry.
After completion of study treatment, patients in phase I are followed for 30 days and patients in phase II are followed periodically.
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| bortezomib | Drug | |||
| pemetrexed disodium | Drug | |||
| gene expression analysis | Genetic | |||
| mutation analysis | Genetic | |||
| protein expression analysis | Genetic | |||
| reverse transcriptase-polymerase chain reaction | Genetic | |||
| flow cytometry | Other |
| Measure | Description | Time Frame |
|---|---|---|
| Number of Patients Experiencing a Dose-limiting Toxicity (Phase I) | Grade 4 thrombocytopenia or grade 3 thrombocytopenia associated with bleeding, requirement for transfusion or lasting >7 days; febrile neutropenia; grade 3 neutropenia associated with infection; any other grade >/=3 non-hematologic toxicity considered by the investigator to be related to study drug. | Up to 36 months |
| Number of Participants Who Experience Adverse Events (Phase I) | Number of participants with treatment-related adverse events as assessed by CTCAE v3.0 (Phase I). | Throughout the entire study (up to 36 months). |
| Number of Patients With Grade ≥ 3 Toxicity (Phase I) | Grade 3/4 toxicity occurring in a patient within 1 cycle. | First cycle of treatment (3 weeks) |
| Number of Patients Who Responded to Study Treatment (Phase II) | To determine the response rate of bortezomib in combination with pemetrexed in patients with advanced NSCLC. Response rate was assessed by CT scan. CT scans was performed at baseline and every two cycles (prior to 3rd and 5th cycle). The evaluation of response was based on standard RECIST criteria. | From start of treatment until disease progression/recurrence. |
| Measure | Description | Time Frame |
|---|---|---|
| Number of Patients With Toxicity by NCI CTC v3.0 (Phase I) | Adverse events possibly related to treatment, graded according to the NCI CTCAE v3.0. | Up to 36 months |
| Maximum Tolerated Dose of Bortezomib in Combination With Pemetrexel (Phase I) |
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DISEASE CHARACTERISTICS:
Cytologically or histologically confirmed diagnosis of 1 of the following:
Advanced solid tumor that progressed after standard therapy or for which no effective curative therapy exists (phase I)
Stage IIIB (pleural effusion) or IV non-small cell lung cancer (NSCLC) (phase II)
Measurable disease
No symptomatic brain metastasis or disease requiring steroids and anticonvulsants
PATIENT CHARACTERISTICS:
Zubrod performance status 0-2 (phase I) or 0-1 (phase II)
Life expectancy ≥ 3 months
Creatinine ≤ 1.5 mg/dL OR creatinine clearance ≥ 50 mL/min
Bilirubin normal
AST ≤ 2.5 times upper limit of normal
Granulocyte count ≥ 1,500/mm³
Platelet count of ≥ 100,000/mm³
Not pregnant or nursing
Negative pregnancy test
Fertile patients must use effective contraception during and for 3 months after completion of study treatment
No pre-existing neuropathy ≥ grade 2
No other prior malignancy except for the following (phase II):
No hypersensitivity to bortezomib, boron, or mannitol
No cardiovascular complications, including any of the following:
Myocardial infarction within the past 6 months
New York Heart Association class III-IV heart failure
Uncontrolled angina
Severe uncontrolled ventricular arrhythmias
Electrocardiographic (ECG) evidence of acute ischemia or active conduction system abnormalities
PRIOR CONCURRENT THERAPY:
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| Name | Affiliation | Role |
|---|---|---|
| Angela Davies, MD | University of California, Davis | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of California Davis Cancer Center | Sacramento | California | 95817 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 18090584 | Result | Davies AM, Ho C, Metzger AS, Beckett LA, Christensen S, Tanaka M, Lara PN, Lau DH, Gandara DR. Phase I study of two different schedules of bortezomib and pemetrexed in advanced solid tumors with emphasis on non-small cell lung cancer. J Thorac Oncol. 2007 Dec;2(12):1112-6. doi: 10.1097/JTO.0b013e31815ba7d0. |
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| ID | Title | Description |
|---|---|---|
| FG000 | Arm A | Pemetrexed on day 1 (500 -600 mg/m2 IV) and bortezomib twice weekly (0.7-1.3mg/m3) on days 1, 4, 8, and 11 every 21 days |
| FG001 | Arm B | Pemetrexed on day 1 (500 -600 mg/m2 IV) and bortezomib twice weekly (0.7-1.3mg/m2) on days 1 and 8 every 21 days |
| Title | Milestones | Reasons Not Completed | |||||
|---|---|---|---|---|---|---|---|
| Phase I |
|
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| immunoenzyme technique | Other |
| immunohistochemistry staining method | Other |
| Up to 36 months |
| Number of Participants With Response to Therapy as Measured by RECIST (Phase I) | Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST) for target lesions and assessed by CT: Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), >=30% decrease in the sum of the longest diameter of target lesions; Best overall response is the best response recorded from the start of the treatment until disease progression/recurrence. | Up to 36 months |
| Number of Participants With Toxicities (Phase II) | Each adverse event will be determined by using the NCI CTCAE, Version 3.0. | Up to 36 months |
| Analysis of Molecular Determinants in Tumor Samples (Phase II) | Expression of relevant molecular targets of the proteasome, which is inhibited by bortezomib. | Up to 36 months |
| Importance of Folate-associated Gene Expression and Response or Outcome (Phase II) | Overexpression of reduced folate carrier (RFC) protein is thought to contribute to decreased resistance to pemetrexed. Levels of expression will be studied by measuring mRNA transcripts using quantitative Reverse Transcriptase-Polymerase Chain Reaction in archival patient tumor specimens. | Up to 36 months |
| Effect of Bortezomib on Over Expression of NF-kB, BCL-2, and BCL-xL (Phase II) | Tumor levels of BCL-2, BCL-xL and BAX will be assessed by immunohistochemistry (IHC). | Up to 36 months |
| COMPLETED |
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| NOT COMPLETED |
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| Phase II |
|
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| ID | Title | Description |
|---|---|---|
| BG000 | Arm A | Pemetrexed on day 1 and bortezomib days 1, 4, 8, and 11 every 21 days |
| BG001 | Arm B | Pemetrexed on day 1 and bortezomib days 1 and 8 every 21 days |
| BG002 | Total | Total of all reporting groups |
| Units | Counts |
|---|---|
| Participants |
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| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Median | Full Range | years |
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| Sex: Female, Male | Count of Participants | Participants |
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| Region of Enrollment | Number | participants |
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| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Number of Patients Experiencing a Dose-limiting Toxicity (Phase I) | Grade 4 thrombocytopenia or grade 3 thrombocytopenia associated with bleeding, requirement for transfusion or lasting >7 days; febrile neutropenia; grade 3 neutropenia associated with infection; any other grade >/=3 non-hematologic toxicity considered by the investigator to be related to study drug. | Posted | Count of Participants | Participants | Up to 36 months |
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| ||||||||||||||||||||||||||||||
| Primary | Number of Participants Who Experience Adverse Events (Phase I) | Number of participants with treatment-related adverse events as assessed by CTCAE v3.0 (Phase I). | Posted | Count of Participants | Participants | Throughout the entire study (up to 36 months). |
|
| |||||||||||||||||||||||||||||||
| Primary | Number of Patients With Grade ≥ 3 Toxicity (Phase I) | Grade 3/4 toxicity occurring in a patient within 1 cycle. | Posted | Number | participants | First cycle of treatment (3 weeks) |
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| |||||||||||||||||||||||||||||||
| Primary | Number of Patients Who Responded to Study Treatment (Phase II) | To determine the response rate of bortezomib in combination with pemetrexed in patients with advanced NSCLC. Response rate was assessed by CT scan. CT scans was performed at baseline and every two cycles (prior to 3rd and 5th cycle). The evaluation of response was based on standard RECIST criteria. | The Phase II study was not conducted. | Posted | No | From start of treatment until disease progression/recurrence. |
|
| |||||||||||||||||||||||||||||||
| Secondary | Number of Patients With Toxicity by NCI CTC v3.0 (Phase I) | Adverse events possibly related to treatment, graded according to the NCI CTCAE v3.0. | Posted | Number | participants | Up to 36 months |
|
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| Secondary | Maximum Tolerated Dose of Bortezomib in Combination With Pemetrexel (Phase I) | Posted | Number | Mg/m^2 | Up to 36 months |
|
| ||||||||||||||||||||||||||||||||
| Secondary | Number of Participants With Response to Therapy as Measured by RECIST (Phase I) | Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST) for target lesions and assessed by CT: Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), >=30% decrease in the sum of the longest diameter of target lesions; Best overall response is the best response recorded from the start of the treatment until disease progression/recurrence. | All patients for whom response evaluation measurements were recorded at baseline and after 2 cycles. | Posted | Count of Participants | Participants | Up to 36 months |
|
| ||||||||||||||||||||||||||||||
| Secondary | Number of Participants With Toxicities (Phase II) | Each adverse event will be determined by using the NCI CTCAE, Version 3.0. | The Phase II study was not conducted. | Posted | Up to 36 months |
|
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| Secondary | Analysis of Molecular Determinants in Tumor Samples (Phase II) | Expression of relevant molecular targets of the proteasome, which is inhibited by bortezomib. | The Phase II study was not conducted. | Posted | Up to 36 months |
|
| ||||||||||||||||||||||||||||||||
| Secondary | Importance of Folate-associated Gene Expression and Response or Outcome (Phase II) | Overexpression of reduced folate carrier (RFC) protein is thought to contribute to decreased resistance to pemetrexed. Levels of expression will be studied by measuring mRNA transcripts using quantitative Reverse Transcriptase-Polymerase Chain Reaction in archival patient tumor specimens. | The Phase II study was not conducted. | Posted | Up to 36 months |
|
| ||||||||||||||||||||||||||||||||
| Secondary | Effect of Bortezomib on Over Expression of NF-kB, BCL-2, and BCL-xL (Phase II) | Tumor levels of BCL-2, BCL-xL and BAX will be assessed by immunohistochemistry (IHC). | The Phase II study was not conducted. | Posted | Up to 36 months |
|
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Arm A | Pemetrexed on day 1 and bortezomib days 1, 4, 8, and 11 every 21 days | 0 | 15 | 15 | 15 | ||
| EG001 | Arm B | Pemetrexed on day 1 and bortezomib days 1 and 8 every 21 days | 0 | 12 | 12 | 12 |
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| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Increased transaminases | Hepatobiliary disorders |
| |||
| Anorexia | Metabolism and nutrition disorders |
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| Constipation | Gastrointestinal disorders |
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| Cough | Respiratory, thoracic and mediastinal disorders |
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| Dehydration | Metabolism and nutrition disorders |
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| Diarrhea | Gastrointestinal disorders |
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| Dizziness | Nervous system disorders |
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| Edema | General disorders |
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| Fatigue | General disorders |
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| Fever | General disorders |
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| Infection | Infections and infestations |
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| Nausea +/- vomiting | Gastrointestinal disorders |
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| Neuropathy | Nervous system disorders |
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| Rash | Skin and subcutaneous tissue disorders |
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| Renal impairment | Renal and urinary disorders |
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| Weakness | Musculoskeletal and connective tissue disorders |
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| Neutropenia | Blood and lymphatic system disorders |
| |||
| Anemia | Blood and lymphatic system disorders |
| |||
| Thrombocytopenia | Blood and lymphatic system disorders |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Analyst | University of California, Davis | 916-734-8053 | nlogihara@ucdavis.edu |
| ID | Term |
|---|---|
| D008175 | Lung Neoplasms |
| D002289 | Carcinoma, Non-Small-Cell Lung |
| ID | Term |
|---|---|
| D012142 | Respiratory Tract Neoplasms |
| D013899 | Thoracic Neoplasms |
| D009371 | Neoplasms by Site |
| D009369 | Neoplasms |
| D008171 | Lung Diseases |
| D012140 | Respiratory Tract Diseases |
| D002283 | Carcinoma, Bronchogenic |
| D001984 | Bronchial Neoplasms |
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| ID | Term |
|---|---|
| D000069286 | Bortezomib |
| D000068437 | Pemetrexed |
| D020869 | Gene Expression Profiling |
| D020133 | Reverse Transcriptase Polymerase Chain Reaction |
| D005434 | Flow Cytometry |
| D007124 | Immunoenzyme Techniques |
| D007150 | Immunohistochemistry |
| ID | Term |
|---|---|
| D001897 | Boronic Acids |
| D000148 | Acids, Noncarboxylic |
| D000143 | Acids |
| D007287 | Inorganic Chemicals |
| D001896 | Boron Compounds |
| D009930 | Organic Chemicals |
| D011719 | Pyrazines |
| D006573 | Heterocyclic Compounds, 1-Ring |
| D006571 | Heterocyclic Compounds |
| D006147 | Guanine |
| D007042 | Hypoxanthines |
| D011688 | Purinones |
| D011687 | Purines |
| D006574 | Heterocyclic Compounds, 2-Ring |
| D000072471 | Heterocyclic Compounds, Fused-Ring |
| D005971 | Glutamates |
| D024342 | Amino Acids, Acidic |
| D000596 | Amino Acids |
| D000602 | Amino Acids, Peptides, and Proteins |
| D000600 | Amino Acids, Dicarboxylic |
| D005821 | Genetic Techniques |
| D008919 | Investigative Techniques |
| D016133 | Polymerase Chain Reaction |
| D021141 | Nucleic Acid Amplification Techniques |
| D002469 | Cell Separation |
| D003584 | Cytological Techniques |
| D019411 | Clinical Laboratory Techniques |
| D019937 | Diagnostic Techniques and Procedures |
| D003933 | Diagnosis |
| D003592 | Cytophotometry |
| D005470 | Fluorometry |
| D008163 | Luminescent Measurements |
| D010783 | Photometry |
| D002623 | Chemistry Techniques, Analytical |
| D007118 | Immunoassay |
| D007158 | Immunologic Techniques |
| D015336 | Molecular Probe Techniques |
| D006651 | Histocytochemistry |
| D006652 | Histological Techniques |
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