Patient case: 72-year-old male with lung adenocarcinoma; genetic feature: EZR-ROS1 fusion

Clinical trial: Study of Vintafolide (MK-8109, EC145) in Participants With Progressive Adenocarcinoma of the Lung (MK-8109-008, EC-FV-03)

Summary: This is a Phase II clinical trial evaluating the benefit from therapy with vintafolide in participants with progressive adenocarcinoma of the lung.

Detailed description: This is a Phase II clinical trial of vintafolide administered to participants with progressive adenocarcinoma of the lung.
  Vintafolide is a drug that is specifically designed to enter cancer cells via the folate vitamin receptor (FR). Experimental evidence shows that this target receptor is expressed on a significant portion of non-small cell lung cancers. Early clinical evidence in a small number of Phase I patients suggests that vintafolide is generally well-tolerated, without many of the side-effects observed in more-standard therapeutic agents. This evidence suggests that vintafolide may be useful as a chemotherapy against progressive adenocarcinomas of the lung. The primary objective of this study is to collect data on clinical benefit produced by therapy with vintafolide .
  All participants will undergo imaging with the FR targeting investigational imaging agent etarfolatide (EC20, FolateScan) during the screening period to confirm eligibility for the treatment portion of the clinical trial. Clinical evidence suggests that etarfolatide may be used to identify patients with cancers that express the target receptor.
  Information about the safety and tolerability of both vintafolide and etarfolatide will be assessed.

Eligibility: Inclusion Criteria:
  -  Advanced, progressive, adenocarcinoma of the lung.
  -  Previously received at least 2 cytotoxic containing chemotherapeutic regimens (can include an epidermal growth factor receptor [EGFR] inhibitor). There is no upper limit to the number of prior chemotherapeutic regimens.
  -  Eastern Cooperative Oncology Group (ECOG) performance status of 0-2.
  -  At least 4 weeks from prior therapy and recovered from associated acute toxicities.
  -  Radiographic evidence of measurable disease and ertafolide "positive" tumor.
  -  Adequate bone marrow reserve, hepatic, and renal function.
  -  Negative serum pregnancy test for women of childbearing potential and willingness to practice contraceptive methods.
  Exclusion Criteria:
  -  Serious comorbidities (as determined by the Principal Investigator).
  -  History of carcinomatous peritonitis.
  -  History of severe bowel obstruction (as determined by the Principal Investigator).
  -  Women who are pregnant or lactating.
  -  Prior radiation therapy to assessable disease, unless disease progression is confirmed at that site.
  -  Participants requiring palliative radiotherapy at time of study entry.
  Note: Participants with central nervous system (CNS) metastasis are eligible if a) they have been treated for the CNS metastasis and have been clinically stable (with regard to their CNS disease) for >4 weeks and b) they do not require steroids or antiseizure medications (i.e., for seizure control), or if the CNS metastasis has been untreated to date, it is not associated with a midline shift or significant edema and there is no clinically-evident requirement for steroids or antiseizure medication. In either situation, participants must be off steroids and/or antiseizure medications for at least 14 days.

Relevance to patient case: not relevant