Neoadjuvant Chemo for Non-metastatic Non-small Cell Lung Cancer

Study Overview
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Brief Summary
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To determine the rate of pathologic complete responses (pCR) at the time of definitive surgical resection of non-small cell lung cancer (NSCLC)

Detailed Description
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Participants in this study will have a lung mass and are undergoing a procedure to determine if they have non-small cell lung cancer that could be removed surgically. If confirmed to have non-small cell lung cancer that can be surgically removed, he or she may be able to continue as a possible participant in this study. The purpose of this study is to determine whether neoadjuvant chemotherapy (chemotherapy that is given before surgery) will improve the amount of time a participant is free from disease in people with non-metastatic (has not spread from the original site) non-small cell lung cancer. The chemotherapy medications that will be used in this study are cisplatin and pemetrexed or cisplatin and gemcitabine and have been shown to be effective in patients with non-small cell lung cancer.

Official Title
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Neoadjuvant Chemotherapy for Non-metastatic Non-small Cell Lung Cancer

Conditions
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Non-squamous Cell Non-Metastatic Non-Small Cell Lung Cancer, Squamous Cell Non-Metastatic Non-Small Cell Lung Cancer

Intervention / Treatment
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* Drug: Cisplatin
* Drug: Pemetrexed
* Drug: Gemcitabine


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients ≥ 18 years of age with either a mass suspicious for or histologically confirmed AJCC stage IB-IIIA NSCLC. For those without histologic confirmation of NSCLC, a biopsy will be done and only those patients with histologically confirmed NSCLC meeting all other eligibility criteria may proceed on protocol. Mass must be determined to be surgically resectable Eastern Cooperative Oncology Group (ECOG) performance status score < 1 and a life expectancy >3 months. Participants must have at least one evaluable lesion as defined by RECIST 1.1 Absolute neutrophil count > 1500 mm3, platelet count ≥ 100×109 L, hemoglobin ≥ 8.5 g/dL Serum creatinine ≤1.3 mg/dL (candidate for cisplatin chemotherapy), total bilirubin ≤ 2 mg/dL, AST/ALT ≤ 5 times the upper limit of normal range No prior chemotherapy or radiotherapy for NSCLC At least 5 years from diagnosis of another cancer except treated in-situ disease or surgically resected non-melanoma skin cancer with clear margins. Willingness to provide permission to biopsy NSCLC for collection of frozen pretreatment sample. Women of child-bearing potential (i.e., women who are pre-menopausal or not surgically sterile) must be willing to use an acceptable contraceptive method (abstinence, oral contraceptive or double barrier method) for the duration of the study and for 30 days following the last dose of study drug, and must have a negative urine or serum pregnancy test within 2 weeks prior to beginning treatment on this trial Exclusion Criteria: Active clinically serious infection > CTCAE (version 4.03) Grade 2. Serious non-healing wound, ulcer, or bone fracture. Major contraindication to surgical resection of NSCLC Inability to complete informed consent process and adhere to the protocol treatment plan and follow-up requirements. Concurrent severe illness such as active infection, or psychiatric illness/social situations that would limit safety and compliance with study requirements. Patients receiving any other investigational agents. Pregnant or lactating females

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: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Cisplatin and pemetrexed<br>Cisplatin on day 1 and pemetrexed on day 1, 1 cycle = 21 days, deliver 4 neoadjuvant cycles | Drug: Cisplatin<br>* Alkylating antineoplastic agent (Chemotherapy)<br>* Other names: Platinol®;Drug: Pemetrexed<br>* Antimetabolite antineoplastic agent (Chemotherapy)<br>* Other names: Alimta®;|
| Experimental: Cisplatin and gemcitabine<br>Cisplatin on day 1 and gemcitabine on days 1 and 8, 1 cycle = 21 days, deliver 4 neoadjuvant cycles | Drug: Cisplatin<br>* Alkylating antineoplastic agent (Chemotherapy)<br>* Other names: Platinol®;Drug: Gemcitabine<br>* Antimetabolite antineoplastic agent (Chemotherapy)<br>* Other names: Gemzar®;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Rate of Pathologic Complete Responses (pCR) at the Time of Definitive Surgical Resection of Non-small Cell Lung Cancer | Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.1) for target lesions and assessed by Magnetic Resonance Imagery (MRI): Complete Response (CR), Disappearance of all target lesions | One year |