Pemetrexed Disodium and Cisplatin Before or After Surgery in Treating Patients With Stage IB or Stage II Non-Small Cell Lung Cancer That Can be Removed by Surgery

Study Overview
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Brief Summary
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RATIONALE: Drugs used in chemotherapy, such as pemetrexed disodium and cisplatin, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Giving more than one drug (combination chemotherapy) before surgery may make the tumor smaller and reduce the amount of normal tissue that needs to be removed. Giving combination chemotherapy after surgery may kill any tumor cells that remain after surgery. It is not yet known whether combination chemotherapy is more effective before or after surgery in treating non-small cell lung cancer. PURPOSE: This randomized phase II trial is studying the side effects of pemetrexed disodium and cisplatin and comparing how well they work when given before or after surgery in treating patients with stage IB or stage II non-small cell lung cancer that can be removed by surgery.

Detailed Description
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OBJECTIVES: Primary Compare the tolerability (in terms of drug delivery and toxicity) of neoadjuvant vs adjuvant chemotherapy comprising cisplatin and pemetrexed disodium in patients with resectable stage IB or II non-small cell lung cancer. Secondary Determine the overall toxicity of this regimen in these patients. Determine the progression-free and overall survival of patients treated with this regimen. Determine the overall clinical response rate, pathologic complete response, and resectability rate in patients treated with neoadjuvant chemotherapy. Determine the surgical morbidity and mortality of patients treated with these regimens. Determine the fraction of patients in the adjuvant arm that receives chemotherapy. OUTLINE: This is a randomized, open-label, multicenter study. Patients are stratified according to institution, histological subtype (squamous vs nonsquamous) and clinical stage (IB vs II). Patients are randomized to 1 of 2 treatment arms. Arm I (neoadjuvant chemotherapy): Patients receive cisplatin IV over 3-6 hours and pemetrexed disodium IV on day 1. Treatment repeats every 21 days for up to 3 courses in the absence of disease progression or unacceptable toxicity. Four to six weeks after completion of chemotherapy, patients undergo surgery. Arm II (adjuvant chemotherapy): Patients undergo surgery. Beginning 4-8 weeks after surgery, patients receive cisplatin and pemetrexed disodium as in arm I. After completion of study treatment, patients are followed periodically for 5 years and then annually thereafter. PROJECTED ACCRUAL: A total of 132 patients will be accrued for this study.

Official Title
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Randomized Phase II Study of Pemetrexed and Cisplatin as Either Induction or Adjuvant Chemotherapy in Stage IB-II Non-Small Cell Lung Cancer (NSCLC)

Conditions
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Lung Cancer

Intervention / Treatment
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* Drug: cisplatin
* Drug: pemetrexed disodium
* Procedure: adjuvant therapy
* Procedure: conventional surgery
* Procedure: neoadjuvant therapy


Participation Criteria
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Eligibility Criteria
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DISEASE CHARACTERISTICS: Pathologically confirmed non-small cell lung cancer (NSCLC) Stage IB or II disease Resectable disease At least 1 measurable lesion No mediastinal involvement by mediastinoscopy and/or positron emission tomography with fludeoxyglucose F 18 scan No evidence of metastatic disease PATIENT CHARACTERISTICS: WHO performance status 0-2 Absolute neutrophil count > 1,500/mm³ Platelet count > 100,000/mm³ Hemoglobin > 10 g/dL Creatinine clearance ≥ 60 mL/min Bilirubin ≤ 1.5 times upper limit of normal (ULN) Alkaline phosphatase ≤ 3.0 times ULN AST and ALT ≤ 3.0 times ULN Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception No other malignant disease, except for the following: Basocellular carcinoma of the skin Adequately treated carcinoma in situ of the cervix Low-grade prostate cancer Other cancer for which the patient has been disease-free for ≥ 5 years No congestive heart failure or angina pectoris unless medically controlled No myocardial infarction within the past 6 months No uncontrolled hypertension or arrhythmia No active uncontrolled infection requiring antibiotics No illness or medical condition that would preclude study participation No pre-existing motor or sensory neurotoxicity ≥ grade 2 PRIOR CONCURRENT THERAPY: No prior surgery for NSCLC No prior or other concurrent chemotherapy for NSCLC No prior or concurrent radiotherapy for NSCLC No concurrent immunotherapy No concurrent targeted agents No concurrent hormonal cancer therapy No concurrent routine colony-stimulating factor (e.g., prophylactic filgrastim [G-CSF]) No aspirin or nonsteroidal anti-inflammatory drugs within 5 days before or after chemotherapy No other concurrent experimental treatments No other concurrent anticancer treatments

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Masking: None (Open Label)


Arms and Interventions

| Intervention/Treatment |
| --- |
|Drug: cisplatin|nan|
|Drug: pemetrexed disodium|nan|
|Procedure: adjuvant therapy|nan|
|Procedure: conventional surgery|nan|
|Procedure: neoadjuvant therapy|nan|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Successful treatment delivery |  |  | 
| Toxicity (no grade 4) during chemotherapy |  |  | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Overall toxicity (all grades) |  |  | 
| Progression-free survival and overall survival |  |  | 
| Overall clinical response rate (neoadjuvant chemotherapy arm) |  |  | 
| Pathologic complete response (neoadjuvant chemotherapy arm) |  |  | 
| Resectability rate (neoadjuvant chemotherapy arm) |  |  | 
| Surgical morbidity and mortality |  |  | 
| Fraction of patients that actually receives chemotherapy (adjuvant chemotherapy arm) |  |  | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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stage I non-small cell lung cancer, stage II non-small cell lung cancer