Patient case: 50-year-old female with Lung cancer. Genetic variant: EGFR (L858R). Other conditions: Lupus.

Clinical trial: A Two-Stage Phase 1 Dose Escalation Pharmacokinetic Study of Tarceva in Patients With Stage IIIB/IV Non-small Cell Lung Cancer Who Continue to Smoke After Failure of One or Two Prior Chemotherapy Regimens

Summary: This is a multicenter, open-label, randomized phase 1 study of escalating doses of Tarceva in patients with advanced NSCLC who currently smoke.
  Part I will establish the maximum tolerated dose (MTD) of Tarceva in current smokers.
  In Part II, patients will be randomized 1:1 to two treatment groups: Arm A (Tarceva MTD established in Part I) and Arm B (150 mg Tarceva daily). Patients in both arms will be treated for two weeks and then have pharmacokinetic samples collected on day 14. Part II is open as of Nov-2006.


Eligibility: Inclusion Criteria:
  -  Histologically or cytologically confirmed diagnosis of stage IIIB/IV NSCLC;
  -  Must have received 1 or 2 prior chemotherapy regimens for advanced NSCLC and now have progressive disease;
  -  Must have recovered from any treatment-related toxicities prior to registration, except for alopecia, grade 1 fatigue, or grade 1 neurotoxicity;
  -  A current cigarette smoker (minimum of 10 cigarettes per day for >= 1 year and have a positive test for cotinine) despite advice and support to quit;
  -  Age >= 18 years;
  -  ECOG PS 0-1 and predicted life expectancy >= 12 weeks;
  -  Previous surgery is permitted provided that wound healing has occurred prior to registration;
  -  Adequate hematopoietic, hepatic and renal function defined as follows: ANC >= 1.5 x 10^9/L, platelets >= 100 x 10^9/L, bilirubin <= 1.5 x ULN, ALT <= 2.5 x ULN (or 5 x ULN in case of liver metastases), creatinine <= 1.5 x ULN;
  -  No prior treatment with Tarceva or gefitinib (or other drug with significant activity against EGFR (eg, cetuximab and/or ZD6474));
  -  Patients with reproductive potential must practice effective contraceptive measures throughout the study. Women of child-bearing potential must provide a negative pregnancy test within 14 days prior to registration;
  -  Accessible for repeat dosing and follow-up.
  Exclusion Criteria:
  -  Any concurrent anticancer cytostatic or cytotoxic chemotherapy;
  -  Concomitant CYP3A4 or CYP1A2 inducers/inhibitors (or during 14 days prior to study) with the exception of tobacco;
  -  Other active malignancies, unless disease-free and without cancer-specific therapy for at least the last 5 years. Basal or squamous cell skin cancers are not excluded;
  -  Significant history of cardiac disease unless the disease is well-controlled;
  -  Active or uncontrolled infections or serious illnesses or medical conditions that could interfere with the patient's ongoing participation in the study;
  -  History of any psychiatric condition that might impair the patient's ability to understand or comply with the requirements; of the study or to provide informed consent.
  -  Gastrointestinal abnormalities, including inability to take oral medication, requirement for IV alimentation, active peptic ulcer or prior surgical procedures affecting absorption;
  -  Clinically significant ophthalmologic abnormalities;
  -  Pregnant or breast-feeding females. Males or females not practicing effective birth control;
  -  Symptomatic brain metastases which are not stable, require steroids, or that have required radiation within the last 28 days;
  -  History of allergic reactions attributed to compounds of similar chemical or biologic composition to the study drug;

Relevance to patient case: not relevant