Pemetrexed Disodium and Gemcitabine in Treating Patients With Stage IIIB or Stage IV Non-Small Cell Lung Cancer

A Randomized Phase II Study of ALIMTA® (Pemetrexed) and GEMZAR® (Gemcitabine) Every 14 Days Versus Pemetrexed and Gemcitabine Every 21 Days in Advanced Non-Small Cell Lung Cancer

RATIONALE: Pemetrexed disodium may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy, such as gemcitabine, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Giving pemetrexed disodium together with gemcitabine may kill more tumor cells.

PURPOSE: This randomized phase II trial is studying two different schedules of pemetrexed disodium and gemcitabine to compare how well they work in treating patients with stage IIIB or stage IV non-small cell lung cancer.

OBJECTIVES:

Primary

• Compare response rates in patients with stage IIIB or IV non-small cell lung cancer treated with two different treatment schedules of pemetrexed disodium and gemcitabine hydrochloride.

Secondary

• Compare time-to-event efficacy variables in patients treated with these regimens.
• Compare progression-free and overall survival of patients treated with these regimens.
• Determine the overall toxicity of these regimens in these patients.

OUTLINE: This is a multicenter, open-label, randomized study. Patients are stratified according to disease stage (IIIB vs IV) and ECOG performance status (0 vs 1). Patients are randomized to 1 of 2 treatment arms.

• Arm I: Patients receive pemetrexed disodium IV over 10 minutes and gemcitabine hydrochloride IV over 30 minutes on days 1 and 8. Treatment repeats every 21 days for up to 6 courses in the absence of disease progression or unacceptable toxicity.
• Arm II: Patients receive pemetrexed disodium IV over 10 minutes and gemcitabine hydrochloride IV over 30 minutes on day 1. Treatment repeats every 14 days for up to 9 courses in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed periodically for up to 2 years.

PROJECTED ACCRUAL: A total of 80 patients will be accrued for this study.

DISEASE CHARACTERISTICS:

• Histologically or cytologically confirmed non-small cell lung cancer (NSCLC)

  • Stage IIIB (with controlled pleural effusion) OR stage IV disease

• At least 1 measurable lesion whose longest diameter is ≥ 20 mm by conventional techniques OR ≥ 10 mm by spiral CT scan

• No medically significant third-space fluid collection (e.g., ascites or pleural effusions) that cannot be controlled by drainage or other procedures

• No documented brain metastases unless all of the following criteria are met:

  • Successful local therapy has been completed
  • At least 2 weeks since prior corticosteroids
  • Brain imaging required for symptomatic patients only (to rule out brain metastases)

• Concurrent enrollment in clinical trial MCCRC-RC0527 required

PATIENT CHARACTERISTICS:

• Life expectancy ≥ 12 weeks

• ECOG performance status 0-1

• Absolute neutrophil count ≥ 1,500/mm³

• Platelet count ≥ 100,000/mm³

• Hemoglobin ≥ 9.0 g/dL

• Bilirubin ≤ 1.5 times upper limit of normal (ULN)

• Alkaline phosphatase ≤ 3 times ULN

• AST and ALT ≤ 3 times ULN (5 times ULN for liver involvement)

• Creatinine clearance ≥ 45 mL/min

• Not pregnant or nursing

• Negative pregnancy test

• Fertile patients must use effective contraception

• Able to take folic acid, cyanocobalamin (vitamin B12) supplementation, or dexamethasone and corticosteroids

• Able to interrupt intake of aspirin and nonsteroidal anti-inflammatory agents for a total of 5 days

• No severe and/or uncontrolled medical conditions, including any of the following:

  • Hypertension, labile hypertension, or history of poor compliance with antihypertensive medication
  • Angina pectoris
  • Congestive heart failure within the past 3 months, unless ejection fraction > 40%
  • Myocardial infarction within the past 6 months
  • Cardiac arrhythmia
  • Diabetes
  • Interstitial pneumonia or extensive and symptomatic interstitial fibrosis of the lung
  • New York Heart Association class III or IV heart disease
  • Clinically significant infection

• No other serious medical condition or illness that would preclude study participation

• No peripheral neuropathy ≥ grade 2

• No other malignancy within the past 5 years except nonmelanomatous skin cancer, carcinoma in situ of the cervix, or low-grade (Gleason score ≤ 6) localized prostate cancer

• No significant weight loss (≥ 10%) within the past 6 weeks

• No investigator site personnel directly affiliated with the study, or immediate family (i.e., spouse, parent, child, or sibling, whether biological or legally adopted)

• No employees of Eli Lilly (i.e., employees, temporary contract workers, or designees responsible for conducting the study)

  • Immediate family of Eli Lilly employees may participate in Eli Lilly-sponsored clinical trials, but are not permitted to participate at an Eli Lilly facility

PRIOR CONCURRENT THERAPY:

• See Disease Characteristics
• At least 2 weeks since prior corticosteroids
• At least 4 weeks since prior radiation therapy involving > 25% of the bone marrow and recovered
• At least 30 days since prior investigational therapy
• No prior radiation therapy to the whole pelvis
• No prior systemic chemotherapy for advanced non-small cell lung cancer
• No prior pemetrexed disodium and/or gemcitabine hydrochloride
• No prior or concurrent sorafenib tosylate and/or temsirolimus
• No concurrent Hypericum perforatum (St. John's wort)
• No other concurrent antitumor therapy
• No concurrent agents that stimulate thrombopoiesis
• Concurrent palliative radiation therapy allowed
• Concurrent corticosteroids allowed for adrenal insufficiency or severe nausea and vomiting