BATTLE Program: ZD6474 in Previously Treated Subjects With NSCLC
Condition: Lung Cancer
MeSH terms: Lung Neoplasms
Intervention: ZD6474
Intervention description: 300 mg by mouth daily for 28 Days.
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 54.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No
Keywords: Non-Small Cell Lung Cancer; NSCLC; Lung Cancer; ZD6474; Zactima; Vandetanib; BATTLE Program

Summary:

      Primary Objective:

        -  To determine the 8 week progression-free survival rate (i.e. disease control rate) in
           patients with advanced NSCLC who have failed at least one prior chemotherapy regimen.

      Secondary Objectives:

        -  Determine the overall response rate

        -  Determine the overall survival

        -  Determine the time to disease progression

        -  Assess the safety/toxicity of the study treatment

        -  Assess biomarker modulation in the tumor tissue and serum samples from the treatment

        -  Assess plasma and intra-tumor concentrations of study treatment
    

Eligibility criteria:

        Inclusion Criteria:

          1. The patient has a diagnosis of pathologically confirmed NSCLC by tumor biopsy and/or
             fine-needle aspiration.

          2. The patient has a diagnosis of either stage IIIB, stage IV, or advanced, incurable
             NSCLC, and failed at least one front-line metastatic NSCLC chemotherapy regimen.
             (Patients who have failed adjuvant or locally advanced therapy within 6 months are
             also eligible to participate in study).

          3. The patient has uni-dimensionally measurable NSCLC.

          4. Karnofsky performance status >/= 60 or Eastern Cooperative Oncology Group (ECOG)
             performance status 0-2

          5. The patient has biopsy accessible tumor.

          6. The patient has adequate hematologic function as defined by an absolute neutrophil
             count (ANC) >/= 1,500/mm^3, platelet count >/= 100,000/mm^3, White Blood Count (WBC)
             >/= 3,000/ mm^3, and hemoglobin >/= 9 g/dL.

          7. The patient has adequate hepatic function as defined by a total bilirubin level </=
             1.5 times the upper limit of normal, and alkaline phosphatase, Alanine
             aminotranferease (ALT) or aspartate aminotransferase (AST) </= 2.5 times the upper
             limit of normal.

          8. The patient has adequate renal function as defined by a serum creatinine level </= 1.5
             mg/dL or a calculated creatinine clearance of >/= 60cc/minute.

          9. The patient has prothrombin time (PT) < 1.5 times upper limit of normal

         10. If patient has brain metastasis, they must have been stable (treated or asymptomatic)
             for at least 4 weeks after radiation if treated with radiation and not have used
             steroids for at least 1 week. Re-imaging performed after 2 weeks, upon completion of
             radiation therapy.

         11. The patient is >/= 18 years of age.

         12. The patient has signed informed consent.

         13. The patient is eligible if disease free from a previously treated malignancy, other
             than a previous NSCLC, for greater than two years. Patients with a history of prior
             basal cell carcinoma of the skin or pre-invasive carcinoma of the cervix are exempt
             from exclusion.

         14. Women of childbearing potential must agree to use adequate contraception (hormonal or
             barrier method of birth control; abstinence) prior to study entry and for the duration
             of study participation.Childbearing potential will be defined as women who have had
             menses within the past 12 months,who have not had tubal ligation or bilateral
             oophorectomy.Should a woman become pregnant or suspect that she is pregnant while
             participating in this study,she should inform her treating physician immediately.The
             patient,if a man,agrees to use effective contraception or abstinence.

         15. Subject must be considered legally capable of providing his or her own consent for
             participation in this study.

        Exclusion Criteria:

          1. The patient has received prior investigational therapy, chemotherapy, surgery, or
             radiotherapy within 4 weeks of initiating study drug

          2. The patient has undergone prior thoracic or abdominal surgery within 28 days of study
             entry, excluding prior diagnostic biopsy.

          3. The patient has received radiation therapy to the measurable tumor within 6 months.
             Patients are allowed to have local irradiation for the management of tumor-related
             symptoms (bones, brain). However, if a patient has active new disease growing in the
             previously irradiated site, the patient will be eligible to participate in the study.

          4. The patient has a significant medical history or unstable medical condition (unstable
             systemic disease: congestive heart failure (New York Heart Association Functional
             Classification class II or worse), recent myocardial infarction within 3 months,
             unstable angina, active infection (i.e. currently treated with antibiotics),
             uncontrolled hypertension). Patients with controlled diabetes will be allowed. Patient
             must be able to undergo procedure for tissue acquisition.

          5. The patient has uncontrolled seizure disorder, active neurologic disease, or
             neuropathy >/= grade 2. Patients with meningeal or CNS involvement by tumor are
             eligible for the study if the above exclusion criteria are not met.

          6. The patient is pregnant (confirmed by serum b-HCG if applicable) or is breastfeeding.

          7. Any condition that is unstable or could jeopardize the safety of the patient and its
             compliance in the study, in the investigator's judgment

          8. The patient is actively taking herbal remedies or over-the-counter biologics (e.g.,
             shark cartilage, high dose antioxidants).

          9. Patients will be allowed to have prior biologic (i.e. VEGF, EGFR, etc.) therapy.
             However, the patient will be excluded from a given study if he/she has received the
             same therapy as the clinical trial (i.e. If a patient has been previously treated with
             bevacizumab, they are allowed to enroll in any of the 4 studies. If a patient has been
             previously treated with erlotinib, they are excluded from the clinical trials with
             erlotinib). In addition, if a patient has been previously treated with gefitinib
             (Iressa), they are excluded from the clinical trials with erlotinib.

         10. Patients must not have undergone minor surgery (e.g., central venous catheter
             placement) within 24 hours of treatment with ZD6474. Patients may not have undergone
             any major surgery (e.g. laparotomy, thoracotomy, or craniotomy) within four weeks of
             enrollment.

         11. Patients may not have a history of a bleeding diathesis.

         12. Significant cardiovascular event (e.g. myocardial infarction, superior vena cava
             syndrome (SVC), New York Heart Association (NYHA) classification of heart disease >/=2
             within 3 months of entry of presence of cardiac disease that in the opinion of the
             investigator increases the risk of ventricular arrhythmia

         13. History of clinically significant arrhythmia (multifocal PVCs, bigeminy, trigeminy,
             ventricular tachycardia), which is symptomatic or requires treatment (CTC grade 3) or
             a symptomatic sustained ventricular tachycardia. Atrial fibrillation, controlled on
             medication is not excluded.

         14. Prior history of QT prolongation as a result from other medication that required
             discontinuation of that medication.

         15. Congenital long QT syndrome or 1st degree relative with unexplained sudden death under
             40 years of age.

         16. QTc with Bazett's correction that is unmeasurable, or >/=480 msec on screening ECG. If
             a patient has QTc >/=480 msec on screening ECG, the screen ECG may be repeated twice
             (at least 24 hours apart). The average QTc from the three screening ECGs must be <480
             msec in order for the patient to be eligible for the study). If the patient meets
             eligibility requirements in this way, the "baseline" QTc for this patient will be the
             average of the 3 ECGs (screen 1, screen 2, and pre-1st dose). Patients who are
             receiving a drug that has a risk of QTc prolongation are excluded if QTc is >/= 460
             msec.

         17. Any concomitant medications that affect QTc, induce Torsades de Pointes. (lists of
             relevant medications available that have a risk of Torsades de Pointes or QTc
             prolongation.) Drugs listed that in the investigator's opinion cannot be discontinued,
             are allowed however, must be monitored closely.

         18. Potassium, calcium (ionized calcium or adjusted for albumin), or magnesium
             concentrations outside normal limits. Supplementation of electrolytes is permitted.
             Potassium level must be greater than or equal to 4.0 meq/L.

         19. Concomitant medications that are potent inducers (rifampicin, rifabutin, phenytoin,
             carbamazepine, phenobarbital and St. John's Wort) of CYP3A4 function.

         20. Hypertension not controlled by medical therapy (systolic blood pressure greater than
             160 mm Hg or diastolic blood pressure greater than 100 mm Hg)

         21. Presence of left bundle branch block (LBBB.)

         22. Any unresolved toxicity greater than common terminology criteria (CTC) grade 1 from
             previous anti-cancer therapy.

         23. Currently active diarrhea that may affect the ability of the patient to absorb the
             ZD6474 or tolerate diarrhea.