Afatinib In Combination With Cisplatin Or Carboplatin + Pemetrexed In Patients With EGFR-Mutant Lung Cancers Undergoing Definitive Chemoradiation

Study Overview
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Brief Summary
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The purpose of this Phase I study is to test the safety of combining afatinib with standard chemotherapy and radiation. The drug afatinib will be given before the chemotherapy and radiation therapy to shrink the tumor and evaluate how afatinib affects the patient. This study will then test the safety of afatinib at different dose levels when combined with the chemotherapy drugs cisplatin or carboplatin, and pemetrexed. These treatments will be given during radiation treatment and the drug afatinib will be continued after chemotherapy and radiation.

Official Title
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A Dose-Finding Study Of Afatinib In Combination With Cisplatin Or Carboplatin + Pemetrexed In Patients With EGFR-Mutant Lung Cancers Undergoing Definitive Chemoradiation

Conditions
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Non-small Cell Lung Cancer

Intervention / Treatment
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* Drug: Afatinib
* Drug: Cisplatin
* Drug: Carboplatin
* Drug: Pemetrexed
* Radiation: Radiation therapy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Unresectable or inoperable, stage III or locoregional recurrence without evidence of distant, metastatic disease Pathologic confirmation of NSCLC at MSKCC Documentation of a sensitizing EGFR mutation Age ≥ 18 years No contraindication to definitive thoracic radiation therapy with concurrent chemotherapy Adequate organ function as defined by: Calculated creatinine clearance≥ 45 mL/min (by Cockcroft-Gault) Total bilirubin less than 1.5 x ULN (unless known Gilbert's disease) and AST/ALT less than 3 x ULN Absolute neutrophil count greater than 1500/mm3 Platelet count greater than 100,000/mm3 Women of childbearing age must have a negative blood pregnancy test Men and women of childbearing potential must be willing to use effective contraception while on treatment and for at least 3 months there after Exclusion Criteria: Prior chemotherapy or radiation therapy for this lung cancer (history of prior lung cancer that has been treated and deeded inactive by the clinician is acceptable) Ineligible for cisplatin or carboplatin per medical oncologist Ineligible for pemetrexed per medical oncologist Greater than minimal, exudative, or malignant pleural effusion Calculated creatinine clearance by Cockcroft & Gault method ≤45 ml/min Unstable congestive heart failure Ejection fraction <50% as assessed by MUGA or echocardiogram Interstitial lung disease Patient requiring on-going treatment with a potent inhibitor (cyclosporin, erythromycin, ketoconazole, itraconazole, quinidine, phenobarbital with quinidine, ritonavir, valspodar, verapamil) or inducer of P-gp (St. John's wort or rifampin) Women who are breastfeeding

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
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Afatinib w Cisplatin Pemetrexed Chemoradiation<br>induction afatinib 40mg daily x 28days Cisplatin or Carboplatin (can be used if patient is not eligible for cisplatin) + Pemetrexed + 50Gy to pretreatment field boost to 60Gy to residual tumor + afatinib dose escalation* *afatinib dose levels: 20mg daily, 30mg daily & 40mg daily (3+3 design) Then adjuvant afatinib x 2 years | Drug: Afatinib<br> <br> Drug: Cisplatin<br> <br> Drug: Carboplatin<br> <br> Drug: Pemetrexed<br> <br> Radiation: Radiation therapy<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| maximum tolerated dose | This will be defined as the dose at which fewer than 1:6 patients experiences a dose-limiting toxicity. | 1 year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| local control rate | will be determined as the proportion of patients who start the concurrent phase who are alive and free of local failure. | at 1 year and at 2 years | 
| tolerability of adjuvant afatinib | Tolerability will be defined by in terms of dose reductions, delays and discontinuations of patients who have not had disease progression or death. | at 3 months | 
| median progression free survival | PFS is defined as the duration of time from start of treatment to time of progression of disease or death, whichever occurs first. | 2 years | 
| median overall survival | will be calculated using Kaplan-Meier estimates among all patients enrolled. | 2 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Afatinib, Cisplatin, Carboplatin, Pemetrexed, Radiation therapy, EGFR mutation, 12-279