Gefitinib in Treating Patients With Stage IB, II, or IIIA Non-small Cell Lung Cancer That Was Completely Removed by Surgery
Condition: Adenocarcinoma of the Lung; Adenosquamous Cell Lung Cancer; Bronchoalveolar Cell Lung Cancer; Large Cell Lung Cancer; Squamous Cell Lung Cancer; Stage IB Non-small Cell Lung Cancer; Stage IIA Non-small Cell Lung Cancer; Stage IIB Non-small Cell Lung Cancer; Stage IIIA Non-small Cell Lung Cancer
MeSH terms: Lung Neoplasms; Carcinoma, Non-Small-Cell Lung; Adenocarcinoma of Lung; Adenocarcinoma, Bronchiolo-Alveolar
Intervention: gefitinib; placebo; laboratory biomarker analysis
Intervention description: Given PO; Given PO; Correlative studies
Intervention MeSH terms: Gefitinib
Phase: Phase 3
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Enrollment: 503.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No

Summary:

      This randomized phase III trial studies how well gefitinib works in treating patients with
      stage IB, II, or IIIA non-small cell lung cancer that was completely removed by surgery.
      Gefitinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell
      growth. It is not yet known if gefitinib may be an effective treatment in preventing tumors
      from returning after they have been removed by surgery.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Patients must have histological proof of a primary non-small cell lung cancer
             (bronchoalveolar carcinomas presenting as a discrete solitary radiological mass or
             nodule are eligible)

          -  Patients must be classified post-operatively as stage IB, II or IIIA on the basis of
             pathologic criteria

          -  At the time of resection a complete mediastinal lymph node resection or at least lymph
             node sampling should have been attempted; if a complete mediastinal lymph node
             resection or lymph node sampling was not undertaken, any mediastinal lymph node which
             measured 1.5 cm or more on the pre-surgical computed tomography (CT)/magnetic
             resonance imaging (MRI) scan or any area of increased uptake in the mediastinum on a
             pre-surgical positron emission tomography (PET) scan must have been biopsied; note: a
             pre-surgical PET scan is not mandatory

               -  The nodal tissue must be labelled according to the recommendations of the
                  American Thoracic Society; surgeons are encouraged to dissect or sample all
                  accessible nodal levels; the desirable levels for biopsy are:

                    -  Right upper lobe: 4, 7, 10

                    -  Right middle lobe: 4, 7, 10

                    -  Right lower lobe: 4, 7, 9, 10

                    -  Left upper lobe: 5, 6, 7, 10

                    -  Left lower lobe: 7, 9, 10

          -  Surgery may consist of lobectomy, sleeve resection, bilobectomy or pneumonectomy as
             determined by the attending surgeon based on the intraoperative findings; patients who
             have had only segmentectomies or wedge resections are not eligible for this study; all
             gross disease must have been removed at the end of surgery; all surgical margins of
             resection must be negative for tumor

          -  No more than 16 weeks may have elapsed between surgery and randomization; for patients
             who received post-operative adjuvant platinum-based chemotherapy, no more than 26
             weeks may have elapsed between surgery and randomization

          -  Patient must consent to provision of and investigator(s) must agree to submit a
             representative formalin fixed paraffin block of tumor tissue at the request of the
             Central Tumor Bank in order that the specific EGFR correlative marker assays may be
             conducted

          -  The patient must have an Eastern Cooperative Oncology Group (ECOG) performance status
             of 0, 1 or 2

          -  Leukocytes >= 3.0 x 10^9/L or >= 3000/ul

          -  Absolute granulocyte count >= 1.5 x 10^9/L or >= 1,500/ul

          -  Platelets >= 100 x 10^9/L or >= 100,000/ul

          -  Total bilirubin within normal institutional limits

          -  Alkaline phosphatase =< 2.5 x institutional upper limit of normal; if alkaline
             phosphatase is greater than the institutional upper limit of normal (UNL) but less
             than the maximum allowed, an abdominal (including liver) ultrasound, CT or MRI scan
             and a radionuclide bone scan must be performed prior to randomization to rule out
             metastatic disease; if the values are greater than the maximum allowed, patients will
             not be considered eligible regardless of findings on any supplementary imaging

          -  Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT])
             and/or alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT])
             =< 2.5 x institutional upper limit of normal; if AST (SGOT) or ALT (SGPT) are greater
             than the institutional upper limit of normal (UNL) but less than the maximum allowed,
             an abdominal (including liver) ultrasound, CT or MRI scan must be performed prior to
             randomization to rule out metastatic disease; if the values are greater than the
             maximum allowed, patients will not be considered eligible regardless of findings on
             any supplementary imaging

          -  Patient must have a chest x-ray done within 14 days prior to randomization; patient
             must have a CT or MRI scan of the chest done within 90 days prior to surgical
             resection if at least one of the following was undertaken:

               -  A complete mediastinal lymph node resection; or

               -  Biopsy of all desired levels of lymph nodes - as specified above; or

               -  A pre-surgical PET scan within 60 days prior to surgical resection If none of the
                  above was undertaken then the CT or MRI scan of the chest must have been
                  performed within 60 days prior to surgical resection Note: a pre-surgical PET
                  scan is not mandatory

          -  Patient must have an electrocardiogram (EKG) done within 14 days prior to
             randomization

          -  Women of childbearing age and men must agree to use adequate contraception (hormonal
             or barrier method of birth control) prior to study entry and while taking study
             medication and for a period of three months after final dose; should a woman become
             pregnant or suspect she is pregnant while she or her male partner are participating in
             this study, she should inform her treating physician immediately

          -  Patients may receive post-operative radiation therapy; patients must have completed
             radiation at least 3 weeks prior to randomization and have recovered from all
             radiation-induced toxicity; patients who have received radiation therapy should also
             be randomized within 16 weeks of surgery

          -  Patient consent must be obtained according to local institutional and/or University
             Human Experimentation Committee requirements; it will be the responsibility of the
             local participating investigators to obtain the necessary local clearance, and to
             indicate in writing to either the National Cancer Institute of Canada (NCIC) Clinical
             Trials Group (CTG) study coordinator (for NCIC CTG centers) or the Cancer Trials
             Support Unit (CTSU) (for all other investigators), that such clearance has been
             obtained, before the trial can commence in that center; a standard consent form for
             the trial will not be provided, but a sample form is given; this sample consent form
             has been approved by the National Cancer Institute (NCI) Central Institutional Review
             Board (IRB) and must be used unaltered by those CTSI centers which operate under CIRB
             authority; for NCIC CTG centers, a copy of the initial full board Research Ethics
             Board (REB) approval and approved consent form must be sent to the NCIC CTG central
             office; please note that the consent form for this study must contain a statement
             which gives permission for the government agencies, NCI, NCIC CTG and monitoring
             agencies to review patient records

               -  NCIC-CTG Centers: the patient must have the ability to understand and the
                  willingness to sign a written informed consent document; the patient must sign
                  the consent form prior to randomization

               -  CTSU Centers: the patient, or in the case of a mentally incompetent patient his
                  or her legally authorized and qualified representative, must have the ability to
                  understand and the willingness to sign a written informed consent document; the
                  consent form must be signed prior to randomization

          -  Patients must be accessible for treatment and follow-up; investigators must assure
             themselves that patients registered on this trial will be available for complete
             documentation of the treatment administered, toxicity and follow-up

          -  Initiation of protocol treatment must begin within 10 working days of patient
             randomization

          -  Patients may have received post-operative adjuvant platinum-based chemotherapy;
             patients must have completed chemotherapy at least 3 weeks prior to randomization and
             have recovered from all chemotherapy-induced toxicity; patients who have received
             adjuvant chemotherapy should also be randomized within 26 weeks of surgery

        Exclusion Criteria:

          -  Prior or concurrent malignancies; patients who have had a previous diagnosis of
             cancer, if they remain free of recurrence and metastases five years or more following
             the end of treatment and, in the opinion of the treating physician do not have a
             substantial risk of recurrence of the prior malignancy, are eligible for the study;
             patients who have been adequately treated for non-melanomatous skin cancer or
             carcinoma in situ of the cervix are eligible irrespective of when that treatment was
             given

          -  A combination of small cell and non-small cell carcinomas or a pulmonary carcinoid
             tumor

          -  More than one discrete area of apparent primary cancer (even if within the same lobe,
             T4, IIIB)

          -  Clinically significant or untreated ophthalmologic (e.g. Sjogren's etc.) or
             gastrointestinal conditions (e.g. Crohn's disease, ulcerative colitis)

          -  Any active pathological condition that would render the protocol treatment dangerous
             such as: uncontrolled congestive heart failure, angina, or arrhythmias, active
             uncontrolled infection, or others

          -  A history of psychiatric or neurological disorder that would make the obtainment of
             informed consent problematic or that would limit compliance with study requirements

          -  Patient, if female, is pregnant or breast-feeding

          -  Neoadjuvant chemotherapy or immunotherapy for NSCLC; however, patients may have
             received pre-operative limited field, low dose (less than 1000 cGy) external beam
             radiation therapy or endobronchial brachytherapy or laser therapy for short term
             control of hemoptysis or lobar obstruction; full dose pre-operative radiotherapy of
             curative intent is a cause for exclusion; patients may have received post-operative
             adjuvant platinum-based chemotherapy however non-platinum-based chemotherapy is a
             cause for exclusion

          -  History of allergic reactions attributed to compounds of similar chemical or biologic
             composition to the agents used on this trial; patients with ongoing use of phenytoin,
             carbamazepine, barbiturates, rifampicin, or St John's Wort are excluded

          -  Incomplete healing from previous oncologic or other major surgery