A Phase I Trial Targeting Mitochondrial Metabolism With Papaverine in Combination With Chemoradiation for Stage II-III Non-Small Cell Lung Cancer
Summary
This phase I trial finds out the best dose, possible benefits and/or side effects of papaverine when given together with chemoradiation intreating patients with stage II-III non-small cell lung cancer. Papaverine targets mitochondrial metabolism to decrease the cancer growth process. Giving papaverine with chemoradiation may work best to treat patients with non-small cell lung cancer.
Detailed description
PRIMARY OBJECTIVE: I. To determine the maximally tolerated dose of papaverine (PPV) in combination with chemoradiation (CRT)/radiation therapy (RT) in patients with unresectable locally advanced (LA) non-small cell lung cancer (NSCLC) or oligometastatic NSCLC. SECONDARY OBJECTIVES: I. To estimate the rates of primary tumor control, local control, time to local-regional progression, disease-free survival (DFS), and overall survival (OS). II. To assess whether blood oxygen level determination (BOLD) functional magnetic resonance imaging (MRI) studies can predict which patients may respond best to PPV + CRT/RT, and detect changes in oxygenation before and after PPV administration. III. To assess whether blood-based and tissue-based biomarkers can predict which patients may respond best to PPV + CRT. OUTLINE: This is a dose-escalation study of PPV. Patients receive PPV intravenously (IV) or subcutaneously (SC) over 30 minutes and patients receiving chemoradiation undergo 5 fractions of radiation therapy (RT) per week for 6 weeks or 5 fractions of hypofractionated RT per week for 3 weeks without chemotherapy. Patients undergoing chemoradiation receive paclitaxel IV and carboplatin IV once weekly (QW) over 1-6 weeks or pemetrexed IV followed by carboplatin IV every 3 weeks during radiation in the absence of disease progression or unacceptable toxicity. Patients with PD-L1 positive disease may also receive durvalumab after completing CRT as considered clinically appropriate by the treating medical oncologist. Patients also undergo positron emission tomography/computed tomography (PET/CT) or CT and brain magnetic resonance imaging (MRI) during screening, and blood sample collection, MRI and CT scans throughout the trial. After completion of the study treatment, patients are followed for 2 years at 1, 3, 6, 9, 12, 16, 20, and 24 months, then periodically for up to 5 years.
Arms & interventions
- DrugCarboplatin
Given IV
- BiologicalDurvalumab
Given IV
- DrugPaclitaxel
Given IV
- DrugPapaverine
Given IV or SC
- RadiationRadiation Therapy
Undergo RT
- DrugPemetrexed
Given IV
- RadiationHypofractionated Radiation Therapy
Undergo hypofractionated RT
- ProcedureMagnetic Resonance Imaging
Undergo MRI
- ProcedurePositron Emission Tomography
Undergo PET/CT
- ProcedureComputed Tomography
Undergo PET/CT or CT
- ProcedureMagnetic Resonance Imaging of the Brain with and without Contrast
Undergo brain MRI
- ProcedureBiospecimen Collection
Undergo blood sample collection
Outcome measures
Primary
Maximally tolerated dose (MTD) of papaverine (PPV) in combination with chemoradiation treatment (CRT) or definitive hypofractionated radiation therapy
Will employ the Time-to-event Bayesian optimal interval design to find the MTD. Treatment-related toxicity will be assessed based on Common Terminology Criteria for Adverse Events version 5.0 criteria.
Time frame: 6 weeks
Secondary
Primary tumor control rate
Time frame: At 12 and 24 months post-treatment
Local control rate
Time frame: At 12 and 24 months post-treatment
Time to local-regional progression
Time frame: From entry on the study until the time of documented local-regional recurrence or death, assessed at 12 and 24 months post-treatment
Disease-free survival
Time frame: From entry on the study until the time of any documented disease recurrence or death, assessed at 12 and 24 months post-treatment
Distant-metastasis-free survival
Time frame: At 12 and 24 months post-treatment
Overall survival
Time frame: From study entry until the time of death from any cause, assessed at 12 and 24 months post-treatment
Changes in magnetic resonance imaging (MRI) blood oxygen level dependent (BOLD) response on MRI
Time frame: Baseline up to 24 months
Changes in blood-based biomarkers related to predict patients response to PPV + CRT
Time frame: Baseline up to 24 months
Changes in tissue-based biomarkers related to predict patients response to PPV + CRT
Time frame: Baseline up to 24 months
Eligibility criteria
Study locations (2)
City of Hope
Duarte, California, 91010
Ohio State University Comprehensive Cancer Center
Columbus, Ohio, 43210