A Phase I-II Trial of MK-0646, a Monoclonal Antibody Against Insulin-Like Growth Factor-1 Receptor, in Combination With Etoposide and Cisplatin in Extensive Stage Small Cell Lung Cancer
A Phase I-II Trial of MK-0646, a Monoclonal Antibody Against Insulin-Like Growth Factor-1 Receptor, in Combination With Etoposide and Cisplatin in Extensive Stage Small Cell Lung Cancer
RATIONALE: Monoclonal antibodies, such as MK-0646, can block tumor growth in different ways. Some block the ability of tumor cells to grow and spread. Others find tumor cells and help kill them or carry tumor-killing substances to them. Drugs used in chemotherapy, such as etoposide and cisplatin, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing.
PURPOSE: This phase I/II trial is studying the side effects and best dose of MK-0646 when given together with etoposide and cisplatin and to see how well it works in treating patients with extensive-stage small cell lung cancer.
OBJECTIVES:
OUTLINE: This is a multicenter, phase I, dose-escalation study of MK-0646 followed by a phase II study.
Patients receive MK-0646 IV over 1 hour on days 1, 8, and 15 and cisplatin IV and etoposide IV once daily on days 1-3. Treatment repeats every 3 weeks for 4 to 8 courses in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients with complete response (CR) or partial response (PR) may continue MK-0646 in the absence of disease progression, with temporary discontinuation while undergoing prophylactic cranial irradiation or thoracic radiotherapy.
Blood samples are collected at baseline (pre-dose) and periodically for biomarker and pharmacogenetic correlative studies. Blood samples are analyzed for changes in expression of IGF biomarkers (e.g., IGF-1, IGF-2 and IGF-PB), haplotype tagging analysis of the IGF-1R, and evaluation of the immunoglobulin G fragment C receptor polymorphisms.
After completion of study therapy, patients are followed at 4 weeks. Patients with responding disease (i.e., CR, PR, or stable disease) are followed every 3 months until relapse or progression.
DISEASE CHARACTERISTICS:
Histologically or cytologically confirmed small cell lung cancer (SCLC)
Clinically and/or radiologically documented measurable disease, defined as ≥ 1 unidimensionally measurable site of disease ≥ 20 mm by chest x-ray, ≥ 15 mm by CT scan (lymph nodes), or ≥ 10 mm by CT scan or physical exam
No uncontrolled or symptomatic CNS metastases
PATIENT CHARACTERISTICS:
Life expectancy ≥ 12 weeks
ECOG performance status 0-2
Absolute granulocyte count ≥ 1,500/mm³
Platelet count ≥ 100,000/mm³
Total bilirubin ≤ upper limit of normal (ULN)
AST and ALT ≤ 3 times ULN (≤ 5 times ULN if documented liver metastases)
Serum creatinine ≤ ULN OR creatinine clearance ≥ 50 mL/min
Not pregnant or lactating
Negative pregnancy test
Fertile patients must use effective contraception during and for at least 3 months after completion of study therapy
No other active cancer
No untreated and/or uncontrolled cardiovascular or other comorbid conditions
No uncontrolled diabetes
Must be accessible for treatment and follow-up
PRIOR CONCURRENT THERAPY:
See Disease Characteristics
No prior cytotoxic chemotherapy or other IGF-1R targeting agents for SCLC
At least 3 weeks since prior radiotherapy to neurological sites
No prior radiotherapy to the lungs
Prior surgery allowed provided that wound healing has occurred
No other concurrent investigational agents or therapy
No other concurrent anticancer treatment
No concurrent radiotherapy