Patient case: 58-year-old female with adenoid cystic carcinoma; genetic feature: KIT

Clinical trial: Combination Chemotherapy and Imatinib Mesylate in Treating Patients With Extensive-Stage Small Cell Lung Cancer

Summary: RATIONALE: Drugs used in chemotherapy work in different ways to stop tumor cells from dividing so they stop growing or die. Imatinib mesylate may stop the growth of tumor cells by blocking the enzymes necessary for their growth. Combining more than one chemotherapy drug with imatinib mesylate may kill more tumor cells.
  PURPOSE: Phase I trial to study the effectiveness of combining cisplatin, irinotecan, and imatinib mesylate in treating patients who have extensive-stage small cell lung cancer.

Detailed description: OBJECTIVES:
  -  Determine the maximum tolerated dose of imatinib mesylate when administered with cisplatin and irinotecan in patients with extensive stage small cell lung cancer.
  -  Determine the recommended phase II dose of imatinib mesylate in patients treated with this regimen.
  -  Determine the response rate, median duration of response, progression-free survival, median survival, and overall survival of patients treated with this regimen.
  OUTLINE: This is a multicenter, dose-escalation study of imatinib mesylate.
  Patients receive cisplatin IV over 1 hour on day 1 and irinotecan IV over 60 minutes on days 1, 8, and 15. Treatment repeats every 28 days for a maximum of 4 courses. Patients also receive oral imatinib mesylate daily continually for one week prior to, during, and after chemotherapy in the absence of disease progression or unacceptable toxicity.
  Cohorts of 3-6 patients receive escalating doses of imatinib mesylate until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity. Once the MTD is determined, additional patients are treated at the recommended phase II dose (one dose level below the MTD).
  PROJECTED ACCRUAL: A total of 12-24 patients will be accrued for this study within 1-2 years.

Eligibility: DISEASE CHARACTERISTICS:
  -  Histologically confirmed extensive stage small cell lung cancer
  -  Incurable but amenable to treatment with chemotherapy
  -  c-kit positive by immunohistochemistry of original biopsy or other metastatic site
  -  At least one unidimensionally measurable lesion
  -  > 20 mm by conventional techniques or > 10 mm by spiral CT scan
  -  No prior radiotherapy to target measurable lesion(s), unless there is documented disease progression
  -  No known brain metastases
  PATIENT CHARACTERISTICS:
  Age
  -  Not specified
  Performance status
  -  ECOG 0-1 OR
  -  Karnofsky 70-100%
  Life expectancy
  -  More than 6 weeks
  Hematopoietic
  -  WBC ≥ 3,000/mm^3
  -  Absolute neutrophil count ≥ 1,500/mm^3
  -  Platelet count ≥ 100,000/mm^3
  Hepatic
  -  Bilirubin normal
  -  AST and/or ALT ≤ 2.5 times upper limit of normal
  Renal
  -  Creatinine normal OR
  -  Creatinine clearance ≥ 60 mL/min
  Cardiovascular
  -  No symptomatic congestive heart failure
  -  No unstable angina pectoris
  -  No cardiac arrhythmia
  Gastrointestinal
  -  No concurrent untreated upper gastrointestinal bleeding that has not been fully investigated
  -  No gastrointestinal disease that would impair drug absorption
  Other
  -  Not pregnant or nursing
  -  Negative pregnancy test
  -  Fertile patients must use effective barrier contraception prior to, during, and for 3 months after study participation
  -  No history of ototoxicity
  -  No history of peripheral neuropathy
  -  No traumatic injury within the past 21 days
  -  No ongoing or active infection
  -  No other concurrent significant medical condition that would preclude study participation
  -  No concurrent psychiatric condition or social situation that would preclude study compliance
  -  No other malignancy within the past 5 years except treated nonmelanoma skin cancer, carcinoma in situ, or stage A prostate cancer
  PRIOR CONCURRENT THERAPY:
  Biologic therapy
  -  Not specified
  Chemotherapy
  -  See Disease Characteristics
  -  No prior chemotherapy
  -  No other concurrent chemotherapy
  Endocrine therapy
  -  Not specified
  Radiotherapy
  -  See Disease Characteristics
  -  More than 4 weeks since prior radiotherapy
  -  No prior radiotherapy to more than 25% of marrow
  Surgery
  -  More than 3 weeks since prior major surgery
  -  No prior surgical procedure impairing absorption
  Other
  -  No prior c-kit-targeted therapy
  -  No concurrent therapeutic dose of warfarin
  -  Mini-dose warfarin for prophylaxis and low-molecular weight heparin allowed
  -  No concurrent combination antiretroviral therapy for HIV-positive patients
  -  No other concurrent investigational agents
  -  No concurrent amifostine
  -  No other concurrent anticancer therapy

Relevance to patient case: not relevant