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This is a Phase 1b pre-operative lung cancer trial wherein patients with operable lung cancer will be treated with RAD001 to evaluate the target effects of this compounds on relevant molecular pathways and on the 18F-2-fluoro-2-deoxy-D-glucose fluorodeoxyglucose (FDG) uptake of the tumor by a positron emission tomography (PET) scan at baseline and immediately prior to surgery. The safety profile of RAD001 will also be evaluated.
This is a Phase 1b pre-operative lung cancer trial wherein patients with operable lung cancer will be treated with RAD001 for 3-4 weeks to study the effects of the novel agent in relevant molecular pathways. The study will also assess the FDG uptake of the tumor at baseline and upon completion of therapy (before surgery) with a PET scan. The safety profile of RAD001 will also be evaluated.
New agents and regimens are urgently needed for lung cancer treatment. With the development of novel agents and small molecules designed to curtail the aggressive aspects of this disease, some progress has been realized. However, much more effort and insight will be required for further real gains to be made. We propose that studying the mammalian target of rapamycin (mTOR) axis, known to be abnormal in non-small cell lung cancer (NSCLC), and translating that knowledge into therapeutic adjustments can lead to meaningful advances in lung cancer treatment.
Approximately 35 patients will participate at Winship Cancer Institute of Emory University in Atlanta, Georgia.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| 1 | Active Comparator | RAD001 5 mg/day for 21 days sequentially. |
|
| 3 | Active Comparator | RAD001 10 mg/day for 21 days sequentially. |
|
| Control | No Intervention | Patients who are eligible for the study but choose not to receive RAD001 treatment. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| RAD001 | Drug | Patients will be assigned to one of three treatment arms with RAD001 doses of 5, and 10 mg/day for 21-28 days sequentially taken orally in tablet form. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Clinical Response as Assessed Metabolically by Changes in Positron Emission Tomography (PET) Scan Between Baseline and Immediately Prior to Surgery. | All patients had baseline imaging in a fasted state with 18F-2-fluoro-2-deoxy-D-glucose fluorodeoxyglucose (18FDG)-PET scan and a repeat scan at 3 to 4 weeks later using routine clinical protocol for patient preparation, radiotracer administration and data acquisition. The repeat imaging occurred no longer than 24 hours before surgical resection. | Day 21 |
| Effects of RAD001 on the Regulation of Key Proteins Involved With the Mammalian Target of Rapamycin (mTOR) Axis in Tumor Specimens and Buccal Mucosa in Patients With Operable Non-small Cell Lung Cancer (NSCLC). | Changes in the expression of key signaling proteins in the mTOR/phosphatidylinositol 3-kinase (PI3K) pathway were determined by immunohistochemistry using previously published protocols and manufacturers' recommendations for antigen retrieval and antibody dilution along with positive and negative controls. Two investigators assessed protein expression jointly by light microscopy. The degree of expression was assessed by intensity (0, 1+, 2+, 3+) and percentage of cell staining in line with published algorithm. A derivative score (immunoscore) ranging between 0 and 300 was calculated as the product of intensity and percent cell staining. | 6 months |
| Inhibition of Proliferation (Ki67) and Induction of Apoptosis (TUNEL Assay) in Tumor Specimens and Buccal Mucosa. | 6 months |
| Measure | Description | Time Frame |
|---|---|---|
| Safety and Tolerability of RAD001 as Pre-operative Therapy. | 6 months | |
| Duration of Hospital Stay Following Surgery. | 6 months |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Suresh Ramalingam, MD | Emory University Winship Cancer Institute | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Emory University Winship Cancer Institute | Atlanta | Georgia | 30322 | United States |
Eligible patients were enrolled concurrently on the active and control arms. Patient preference for a specific arm was entertained until the control cohort was completely filled after which all patients were competitively enrolled on the active treatment arm of the study.
All enrolled patients were recruited through the multidisciplinary thoracic oncology clinics of Emory Clinic of Emory University.
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| ID | Title | Description |
|---|---|---|
| FG000 | Control | No everolimus taken. |
| FG001 | Everolimus 5 mg | Everolimus dose of 5 mg/day for 21-28 days sequentially taken orally in tablet form. |
| FG002 | Everolimus 10 mg | Everolimus dose of 10 mg/day for 21-28 days sequentially taken orally in tablet form. |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
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| ID | Title | Description |
|---|---|---|
| BG000 | Control | No everolimus taken. |
| BG001 | Everolimus 5 mg | Everolimus dose of 5 mg/day for 21-28 days sequentially taken orally in tablet form. |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Median |
| 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 | Clinical Response as Assessed Metabolically by Changes in Positron Emission Tomography (PET) Scan Between Baseline and Immediately Prior to Surgery. | All patients had baseline imaging in a fasted state with 18F-2-fluoro-2-deoxy-D-glucose fluorodeoxyglucose (18FDG)-PET scan and a repeat scan at 3 to 4 weeks later using routine clinical protocol for patient preparation, radiotracer administration and data acquisition. The repeat imaging occurred no longer than 24 hours before surgical resection. | Posted | Number | percentage of patients | Day 21 |
|
4 weeks
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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 | Control | No everolimus taken. |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Symptomatic Progression of Lung Cancer | Neoplasms benign, malignant and unspecified (incl cysts and polyps) | Non-systematic Assessment | One subject was enrolled to the study and was receiving RAD001 therapy. During week 2, she was hospitalized for symptomatic progression of her lung cancer. |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Hyperglycemia | Blood and lymphatic system disorders | Non-systematic Assessment |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Suresh S. Ramalingam, MD | Emory University | 404-778-5378 | ssramal@emory.edu |
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| ID | Term |
|---|---|
| D008175 | Lung Neoplasms |
| ID | Term |
|---|---|
| D012142 | Respiratory Tract Neoplasms |
| D013899 | Thoracic Neoplasms |
| D009371 | Neoplasms by Site |
| D009369 | Neoplasms |
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| ID | Term |
|---|---|
| D000068338 | Everolimus |
| ID | Term |
|---|---|
| D020123 | Sirolimus |
| D018942 | Macrolides |
| D007783 | Lactones |
| D009930 | Organic Chemicals |
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|
| BG002 | Everolimus 10 mg | Everolimus dose of 10 mg/day for 21-28 days sequentially taken orally in tablet form. |
| BG003 | Total | Total of all reporting groups |
| years |
|
| Gender | Count of Participants | Participants |
|
| Race (NIH/OMB) | Count of Participants | Participants |
|
| Region of Enrollment | Number | participants |
|
| OG002 | Everolimus 10 mg | Everolimus dose of 10 mg/day for 21-28 days sequentially taken orally in tablet form. |
|
|
| Primary | Effects of RAD001 on the Regulation of Key Proteins Involved With the Mammalian Target of Rapamycin (mTOR) Axis in Tumor Specimens and Buccal Mucosa in Patients With Operable Non-small Cell Lung Cancer (NSCLC). | Changes in the expression of key signaling proteins in the mTOR/phosphatidylinositol 3-kinase (PI3K) pathway were determined by immunohistochemistry using previously published protocols and manufacturers' recommendations for antigen retrieval and antibody dilution along with positive and negative controls. Two investigators assessed protein expression jointly by light microscopy. The degree of expression was assessed by intensity (0, 1+, 2+, 3+) and percentage of cell staining in line with published algorithm. A derivative score (immunoscore) ranging between 0 and 300 was calculated as the product of intensity and percent cell staining. | Posted | Mean | Standard Deviation | % change in immunoscore | 6 months |
|
|
|
| Primary | Inhibition of Proliferation (Ki67) and Induction of Apoptosis (TUNEL Assay) in Tumor Specimens and Buccal Mucosa. | Not Posted | 6 months | Participants |
| Secondary | Safety and Tolerability of RAD001 as Pre-operative Therapy. | Not Posted | 6 months | Participants |
| Secondary | Duration of Hospital Stay Following Surgery. | Posted | Median | Full Range | days | 6 months |
|
|
|
| 0 |
| 10 |
| 0 |
| 10 |
| EG001 | Everolimus 5 & 10 mg | Everolimus dose of 5 or 10 mg/day for 21-28 days sequentially taken orally in tablet form. | 1 | 23 | 21 | 23 |
|
| Cough | Respiratory, thoracic and mediastinal disorders | Non-systematic Assessment |
|
| Elevated Cholesterol | Vascular disorders | Non-systematic Assessment |
|
| Fatigue | General disorders | Non-systematic Assessment |
|
| Diarrhea | Gastrointestinal disorders | Non-systematic Assessment |
|
| Night Sweats | General disorders | Non-systematic Assessment |
|
| Fever | General disorders | Non-systematic Assessment |
|
| Elevated Creatinine | Renal and urinary disorders | Non-systematic Assessment |
|
| Insomnia | General disorders | Non-systematic Assessment |
|
| Hoarseness | General disorders | Non-systematic Assessment |
|
| Heartburn | Gastrointestinal disorders | Non-systematic Assessment |
|
| Weight-loss | Metabolism and nutrition disorders | Non-systematic Assessment |
|
| Dyspnea | Respiratory, thoracic and mediastinal disorders | Non-systematic Assessment |
|
| Nausea | General disorders | Non-systematic Assessment |
|
| Elevated ALT | Blood and lymphatic system disorders | Non-systematic Assessment |
|
| Elevated AST | Blood and lymphatic system disorders | Non-systematic Assessment |
|
| Elevated Alkaline Phosphatase | Blood and lymphatic system disorders | Non-systematic Assessment |
|
| Hypocalcemia | Blood and lymphatic system disorders | Non-systematic Assessment |
|
| Hyponatremia | Blood and lymphatic system disorders | Non-systematic Assessment |
|
| Hypokalemia | Blood and lymphatic system disorders | Non-systematic Assessment |
|
| Anemia | Blood and lymphatic system disorders | Non-systematic Assessment |
|
| Hypophosphatemia | Blood and lymphatic system disorders | Non-systematic Assessment |
|
| Hypoalbuminemia | Blood and lymphatic system disorders | Non-systematic Assessment |
|
| Vertigo | Ear and labyrinth disorders | Non-systematic Assessment |
|
| Productive Cough | Respiratory, thoracic and mediastinal disorders | Non-systematic Assessment |
|
| Difficulty in Breathing | Respiratory, thoracic and mediastinal disorders | Non-systematic Assessment |
|
| Hypertriglyceridemia | Blood and lymphatic system disorders | Non-systematic Assessment |
|
| Headache | Nervous system disorders | Non-systematic Assessment |
|
| Low Leukocytes | Immune system disorders | Non-systematic Assessment |
|
| Mouth Sores | Skin and subcutaneous tissue disorders | Non-systematic Assessment |
|
| Chest Pain | Respiratory, thoracic and mediastinal disorders | Non-systematic Assessment |
|
| Sore Throat | Respiratory, thoracic and mediastinal disorders | Non-systematic Assessment |
|
| Bronchitis | Infections and infestations | Non-systematic Assessment |
|
| Mucositis | Gastrointestinal disorders | Non-systematic Assessment |
|
| Constipation | Gastrointestinal disorders | Non-systematic Assessment |
|
| Arthralgia | Musculoskeletal and connective tissue disorders | Non-systematic Assessment |
|
| Reflux | Gastrointestinal disorders | Non-systematic Assessment |
|
| Eczema | Skin and subcutaneous tissue disorders | Non-systematic Assessment |
|
| Hemoptysis | Respiratory, thoracic and mediastinal disorders | Non-systematic Assessment |
|
| Burning with Urination | Renal and urinary disorders | Non-systematic Assessment |
|
| Pain in Lower Flank | General disorders | Non-systematic Assessment |
|
| Intermittent Discomfort in Left Leg | General disorders | Non-systematic Assessment |
|
| Depression | Psychiatric disorders | Non-systematic Assessment |
|
| Low Platelets | Blood and lymphatic system disorders | Non-systematic Assessment |
|
| Respiratory Failure | Respiratory, thoracic and mediastinal disorders | Non-systematic Assessment |
|
| MRSA Bacteremia | Infections and infestations | Non-systematic Assessment |
|
| Acute Renal Failure | Renal and urinary disorders | Non-systematic Assessment |
|
| Malaise | General disorders | Non-systematic Assessment |
|
| Rash | Skin and subcutaneous tissue disorders | Non-systematic Assessment |
|
| Upper Respiratory Infection | Infections and infestations | Non-systematic Assessment |
|
| Anxiety | Psychiatric disorders | Non-systematic Assessment |
|
| Edema | Blood and lymphatic system disorders | Non-systematic Assessment |
|
| Hyperbilirubinemia | Blood and lymphatic system disorders | Non-systematic Assessment |
|
| Tinnitus | Ear and labyrinth disorders | Non-systematic Assessment |
|
| Myalgia | Musculoskeletal and connective tissue disorders | Non-systematic Assessment |
|
| Sinusitis | Musculoskeletal and connective tissue disorders | Non-systematic Assessment |
|
| Odynophagia | Respiratory, thoracic and mediastinal disorders | Non-systematic Assessment |
|
| Pain | Nervous system disorders | Non-systematic Assessment |
|
| Neuropathy | Nervous system disorders | Non-systematic Assessment |
|
| Dizziness | General disorders | Non-systematic Assessment |
|
| Restlessness | General disorders | Non-systematic Assessment |
|
| Erythema | Skin and subcutaneous tissue disorders | Non-systematic Assessment |
|
| Confusion | General disorders | Non-systematic Assessment |
|
| Loss of Energy | General disorders | Non-systematic Assessment |
|
| Difficulty in Walking | General disorders | Non-systematic Assessment |
|
| Loss of Balance | General disorders | Non-systematic Assessment |
|
| Hot Flashes | Endocrine disorders | Non-systematic Assessment |
|
| Hypercalcemia | Blood and lymphatic system disorders | Non-systematic Assessment |
|
| Conjuctivitis | Eye disorders | Non-systematic Assessment |
|
| Photosensitivity | General disorders | Non-systematic Assessment |
|
| Thrombocytopenia | Blood and lymphatic system disorders | Non-systematic Assessment |
|
| Leukopenia | Blood and lymphatic system disorders | Non-systematic Assessment |
|
| Ear Ache | Ear and labyrinth disorders | Non-systematic Assessment |
|
| Urinary Frequency | Renal and urinary disorders | Non-systematic Assessment |
|
| Cramping Feet | General disorders | Non-systematic Assessment |
|
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| D008171 |
| Lung Diseases |
| D012140 | Respiratory Tract Diseases |
|
| pS6/S6 |
|
| pMTOR |
|
| p4E-BP1 |
|
| p70s6k |
|
| p70s6k Cytoplasmic |
|
| p70s6k Nuclear |
|
| pe1f4e |
|
| PAKT Nuclear |
|
| PAKT Cytoplasmic |
|
| Bim |
|