Phase II Study of Dasatinib in Previously Treated Patients With Advanced NSCLC
Condition: Non Small Cell Lung Cancer
MeSH terms: Lung Neoplasms; Carcinoma, Non-Small-Cell Lung
Intervention: Dasatinib
Intervention description: 70 mg PO twice daily until progression. Re-assess radiographically every 6 weeks.
Intervention MeSH terms: Dasatinib
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 37.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No
Keywords: NSCLC; Lung Cancer; Dasatinib; Genomics; Genomics analysis; Genomic signature

Summary:

      On this study patients will receive dasatinib, a targeted therapy, for advanced NSCLC that
      has progressed after previous therapy. Safety and response to dasatinib will be assessed.

      Fresh frozen tumor tissue must be available for genomics analysis prior to initiating
      dasatinib therapy. A biopsy must be obtained after any prior chemotherapy. If fresh frozen
      tumor tissue is not available, a biopsy will be required to participate in this trial.
    

Eligibility criteria:

        Inclusion Criteria:

          1. Histological/cytological documented non-small cell lung cancer (NSCLC). Documentation
             of recurrence required if treated with surgical resection and/or external beam
             radiation therapy (XRT) with curative intent and now have recurrent disease.

          2. Fresh tissue biopsy material for genomics analysis prior to initiating dasatinib. If
             prior XRT, tissue biopsy must be outside XRT field. Biopsy must be after any prior
             chemotherapy.

          3. Prior treatment (tx) to include one of the following:

               -  At least 1 prior systemic regimen (IV or oral agent) for Stage IV NSCLC or for
                  recurrent disease.

               -  Recurrence within 12 months after completion of systemic neoadjuvant/adjuvant
                  chemotherapy for early stage NSCLC.

               -  Combined modality platinum-based tx for Stage III NSCLC.

          4. Prior XRT permitted if ≥1 week since completion, XRT must be <25% of bone marrow
             reserve.

          5. At least one, non-radiated, measurable lesion (per RECIST).

          6. Age ≥18 years.

          7. Eastern Cooperative Oncology Group (ECOG) 0-2.

          8. Adequate Organ Function:

               1. Total bilirubin < Upper limit normal (ULN)

               2. Hepatic enzymes (AST, ALT) ≤2.5x ULN

               3. Serum creatinine <1.5x ULN

               4. Hemoglobin ≥9 gm/dL

               5. Neutrophil count (ANC/AGC) ≥1500 per μL

               6. Platelets ≥100,000 per μL

               7. Prothrombin time (PT)/a Partial thromboplastin time (PTT) ≤1.5x control

          9. No other serious medical or psychiatric illness.

         10. Ability to take oral medication (dasatinib must be swallowed whole).

         11. Women of childbearing potential must have negative serum pregnancy test ≤72 hours and
             not >7 days prior to starting study drug.

         12. Sexually active males and females of reproductive potential must agree to use adequate
             method of contraception during tx and for at least 4 weeks after study drug stopped.

         13. Signed, written informed consent including Health Insurance Portability and
             Accountability Act (HIPAA) according to institutional guidelines.

        Exclusion Criteria:

          1. Previous or concomitant malignancy in past 2 years other than curatively treated
             carcinoma in situ of cervix, or basal cell/squamous cell carcinoma of the skin.

          2. Prior tx with dasatinib or other agents that inhibit Src.

          3. Evidence of symptomatic pleural effusions (grade 2) unless undergo therapeutic
             thoracentesis as part of non-study care. Successful pleurodesis allowed. Patients who
             require supplemental oxygen or with oxygen saturation on room air <89% are not
             eligible. Pericardial effusions of any grade are not eligible.

          4. Untreated documented symptomatic central nervous system (CNS) metastases.

          5. Cardiac Symptoms:

               1. Uncontrolled angina, congestive heart failure(CHF)or myocardial infarction within
                  6 months

               2. Diagnosed congenital long QT syndrome

               3. Any h/o clinically significant ventricular arrhythmias

               4. Prolonged QT corrected (QTc) interval on pre-entry EKG (>450 msec)

               5. Uncontrolled B/P as defined as >160/90 on B/P therapy

          6. Hypokalemia or hypomagnesaemia if it cannot be corrected.

          7. H/o diagnosed congenital acquired bleeding disorders.

          8. Ongoing or recent (≤3 months) significant (≥grade 3) GI bleeding.

          9. Con Meds:

               1. Drugs having risk of causing Torsades de Pointes (must stop drug 7 days before
                  dasatinib);

               2. Current therapeutic dose unfractionated heparin, low-molecular weight heparin, or
                  coumadin therapy;

               3. St. John's Wort must be stopped while on dasatinib;

               4. IV bisphosphonates stopped 2 weeks pre/6 weeks post dasatinib.

         10. Prisoners/subjects compulsorily detained for tx of psychiatric and/or physical
             illness.

         11. Pregnant or breastfeeding.

         12. Active or uncontrolled infection requiring IV antibiotics.

         13. Impairment of GI function/disease that may alter absorption of dasatinib (e.g.,
             ulcerative diseases, uncontrolled nausea, vomiting, diarrhea, malabsorption syndrome,
             or small bowel resection).

         14. Received investigational drugs ≤4 weeks prior to starting study drug and/or not
             recovered from side effects of such therapy. Any other anti-neoplastic and/or
             molecular therapy must be discontinued 7 days prior to starting dasatinib.