Patient case: 64-year-old female with Lung adenocarcinoma. Genetic variant: ALK Fusion. Other conditions: Emphysema.

Clinical trial: Study of AVE0005 (VEGF Trap) in Locally Advanced or Metastatic Platinum- and Erlotinib- Resistant Non-small-cell-lung Adenocarcinoma

Summary: This study evaluated the efficacy and safety of aflibercept in the treatment of participants with advanced chemoresistant non-small cell lung adenocarcinoma (NSCLA).
  Primary objective:
  -  To determine the overall objective response rate (ORR) of AVE0005 (ziv-aflibercept, aflibercept, VEGF trap, ZALTRAP®) 4.0 mg/kg intravenously (IV) every 2 weeks in participants with platinum- and erlotinib-resistant, locally advanced or metastatic NSCLA.
  Secondary objective:
  -  To assess duration of response (DR), progression-free survival (PFS), and overall survival (OS) in this participant population
  -  To evaluate the safety profile of IV AVE0005 (ziv-aflibercept, aflibercept, VEGF trap, ZALTRAP®).
  This study employed an Independent Review Committee (IRC) for radiological tumor assessments. For all tumor assessment-related efficacy variables, two analyses were performed: the primary analysis was based on Independent Review Committee (IRC) reviewed data and the secondary analysis was based on Investigator evaluation.
  In addition, both Response Evaluation Criteria In Solid Tumors (RECIST) and Modified Response Evaluation Criteria In Solid Tumors (mRECIST) were used to assess tumors. Where as RECIST criteria only consider the longest diameter of the tumors for calculations pertaining to changes in tumor size, mRECIST assessments also account for the differences in the cavities of lesions observed in non-small-cell lung cancer (NSCLC). Responses based on RECIST and mRECIST are reported.

Detailed description: The study included :
  -  A screening phase up to 21 days followed by registration
  -  Treatment initiation within 5 working days of registration
  -  A treatment phase with 14-day study treatment cycles until a study withdrawal criterion was met or up to the clinical database cut-off date (18 July 2008)
  -  A follow-up phase - up to 60 days after end of treatment
  Withdrawal criteria that led to treatment discontinuation were:
  -  The participant or their legally authorized representative requested to withdraw
  -  In the investigator's opinion, continuation of the study would be detrimental to the participant's well being, due to reasons such as disease progression, unacceptable toxicity, noncompliance, or logistical considerations.
  -  A specific request by the Sponsor
  -  Participant had intercurrent illness that prevented further administration of study treatment
  -  Participant had more than 2 aflibercept dose reductions
  -  Participant had arterial thromboembolic events, including cerebrovascular accidents, myocardial infarctions, transient ischemic attacks, new onset or worsening of pre-existing angina
  -  Participant had radiographic evidence of intestinal obstruction (e.g., dilated loops of bowel accompanied by air-fluid levels) or gastrointestinal perforation (e.g., presence of extraluminal gas) requiring surgical intervention
  -  Participant was lost to follow-up
  After discontinuing treatment, participants remained on the study until the last post-treatment visit or until recovery of drug related toxicities, whichever was later.

Eligibility: Participants who met the following criteria were eligible for the study.
  Inclusion Criteria:
  -  Histologically confirmed non-small-cell lung adenocarcinoma that is locally advanced or metastatic
  -  Prior treatment with at least 2 cancer drug regimens in the advanced disease setting
  -  Platinum- and erlotinib-resistant disease defined by relapse or progression during or after treatment
  -  Measurable disease by RECIST criteria
  -  ECOG Performance status less than or equal to 2
  -  Resolution of any toxic effects of prior therapy
  -  Adequate organ and bone marrow function
  -  Female patients must be post-menopausal, surgically sterile or using effective contraception
  -  Willing and able to comply with study procedures and sign informed consent
  Exclusion Criteria:
  -  Diagnosis of squamous-cell lung cancer or any second malignancy within the last 5 years (except for adequately treated basal cell or squamous cell skin cancer or in situ carcinoma of the cervix uteri)
  -  Prior treatment with a VEGF or VEGF receptor inhibitor with the exception of bevacizumab (Avastin-TM)
  -  Anticipation of a need for major surgical procedure
  -  Treatment with chemotherapy, radiotherapy, surgery, blood products, or an investigational agent within 3 weeks (6 weeks for nitrosoureas, mitomycin C, immunotherapy, or cytokine therapy) of study enrollment
  -  Uncontrolled hypertension
  -  Any severe or acute medical or psychiatric problem within the past 6 months requiring further investigation or that may cause undue risk for the patient's safety
  -  History of brain metastases, spinal cord compression, or carcinomatous meningitis, or new evidence of brain or leptomeningeal disease
  -  Active infection or on antiretroviral therapy for HIV disease
  -  Pregnant or breast-feeding
  The above information is not intended to contain all considerations relevant to potential participation in a clinical trial.

Relevance to patient case: not relevant