Patient case: 65-year-old female with squamous cell lung cancer; genetic feature: FGFR1 amplification

Clinical trial: Dasatinib in Advanced Squamous Cell Lung Cancer

Summary: Dasatinib is a drug that has been shown to stop some cancer cells from growing. This drug has been used in treatment for other types of cancer and information from other research studies suggests that dasatinib may help to stop squamous cell lung cancer from growing, especially in individuals whose tumor has a mutation in the DDR2 gene.
  Advanced squamous cell lung cancer (SqCC) carries a poor prognosis and new therapeutic targets are needed. Several studies have examined dasatinib in NSCLC; these report significant toxicities, but also responses in patients found to harbor mutations in DDR2 or BRAF.
  An open-label phase II trial with dasatinib was carried out to determine the response rates in patients with SqCC who had previously failed standard chemotherapy and to correlate responses with patient genotype.

Detailed description: Dasatinib will be taken orally, daily in cycles of 28 days.
  On the first day of study treatment and at 2 weeks, 4 weeks and then every 4 weeks subjects will have the following:
  -  Medical history and clinical exam
  -  Safety blood tests
  -  Measurement of Performance Status
  -  Review of pill log
  -  CT scans will be done every 8 weeks.
  In this research study, the investigators are looking at how well dasatinib works in treating squamous cell lung cancer.
  Dasatinib administered at 140mg per day for the treatment of advanced SqCC of the lung is associated with excess adverse events, similar to other studies, so is not recommended in unselected patients. Further work to identify patients likely to benefit from dasatinib and in managing dasatinib-related toxicities is needed.

Eligibility: Inclusion Criteria:
  -  Stage III/B or IV squamous NSCLC
  -  Measurable disease
  -  Previously offered all standard chemotherapy regimens for advanced squamous cell lung cancer
  -  ECOG performance status of 0 or 1
  -  Estimated life expectancy greater than 12 weeks
  -  Normal organ and marrow function
  -  Confirmed availability of archival pathology samples
  -  Agrees to discontinue St. Johns Wort
  -  Able to take medications by mouth
  -  Willing and able to use acceptable method of birth control for the entire study period and for at least 4 weeks after the last dose of study drug
  Exclusion Criteria:
  -  Pregnant or breast-feeding
  -  Chemotherapy or radiotherapy within 4 weeks prior to entering study
  -  Receiving any other investigational agents
  -  Known untreated or progressive brain metastases
  -  History of prior treatment with or allergic reactions attributed to compounds of similar chemical or biologic composition to dasatinib, nilotinib or imatinib
  -  Taking medications known to be potent CYP3A4 inhibitors
  -  Currently taking H2 inhibitors or proton pump inhibitors
  -  Currently taking drugs or have taken drugs in the past 7 days that are generally accepted to have a risk of causing Torsades de Pointes
  -  HIV positive
  -  Clinically uncontrolled hypertension (blood pressure > 160/110)
  -  Previous or concurrent malignancy except adequately treated basal or squamous cell skin cancer, in situ carcinoma of the cervix, or other solid tumor treated curatively, and without evidence of recurrence for at least 5 years
  -  Active and uncontrolled clinically significant infection
  -  Chronic gastrointestinal disease
  -  Acquired or congenital bleeding disorder or clinically significant gastrointestinal bleeding within 3 months
  -  Supplemental oxygen required for current malignancy
  -  Evidence of symptomatic pleural effusions unless undergoing a therapeutic thoracentesis as part of non-study care
  -  Individuals who are prisoners or who are compulsory detained for medical or psychiatric reasons
  -  Uncontrolled intercurrent illness including, but not limited to ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, symptomatic cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
  -  Hypokalemia or hypomagnesemia that cannot be corrected prior to dasatinib administration

Relevance to patient case: not relevant