Temozolomide as Maintenance Therapy Following Induction Chemotherapy in Extensive Stage Small Cell Lung Cancer

Study Overview
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Brief Summary
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Temozolomide may delay progression in sequence with chemotherapy. This open-label, randomized,multicenter phase II trial was designed to evaluate the role of Temozolomide following 4 or 6 cycles of platinum-based first-line chemotherapy in patients with newly diagnosed estensive-stage SCLC.

Conditions
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Extensive-stage Small Cell Lung Cancer

Intervention / Treatment
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* Drug: Temozolomide
* Drug: first-line chemotherapy
* Radiation: Prophylactic cranial irradiation
* Radiation: thoracic radiotherapy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Cytologically and/or histologically confirmed small-cell lung cancer with extensive-stage disease Patients must have measurable disease, this can include brain metastases Eastern Cooperative Oncology Group (ECOG) Performance Status of 0-1 Adequate bone marrow function, as defined by: absolute neutrophil count (ANC) >1,500/µL; platelets >100,000/µL; hemoglobin >=9.0 g/dL Normal organ function, defined as follows: aspartate aminotransferase (AST) and alanine aminotransferase (ALT) <=2.5 × the upper limit of normal (ULN), or AST and ALT <=5 × the ULN if liver function abnormalities are due to underlying malignancy; total serum bilirubin <=1.5 × the ULN; serum creatinine <=1.5 × the ULN the time interval from the data of the last chemotherapy to random must be between 3 and 7 weeks Women of childbearing potential and men with partners of childbearing potential must agree to use a form of birth control that is acceptable to their physician to prevent pregnancy during treatment Patients must be informed of the investigational nature of this study and sign an informed consent form Exclusion Criteria: Patients who are pregnant or breastfeeding Patients receiving other investigational agents Patients with leptomeningeal involvement Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, or psychiatric illness/social situations that would limit compliance with study requirements Acquired Immune Deficiency Syndrome (AIDS) based upon current CDC definition or HIV-positive patients on combination antiretroviral therapy. However, HIV testing is not required for entry into this protocol. The need to exclude patients with AIDS from this protocol is necessary because these patients are at increased risk of lethal infections when treated with marrow- suppressive therapy. Excluding patients on HAART is necessary due to the potential for pharmacokinetic interactions with temozolomide.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 75 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
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: BSC group<br>Patients in the study will receive the following for the duration of the study:First-line chemotherapy according to the NCCN guidelines. The study will consist of 21-day cycles, to a maximum of 6 cycles of therapy for the first-line chemotherapy. Radiotherapy was allowed. Follow-up until disease progression. | Drug: first-line chemotherapy<br>* first-line chemotherapy must be platinum-based: cisplatin(75mg/m2 for d1) or carboplatin（AUC 5 for d1) combined with etoposide（100mg/m2 for d1-d3）<br>Radiation: Prophylactic cranial irradiation<br>* Prophylactic cranial irradiation was allowed if necessary<br>Radiation: thoracic radiotherapy<br>* thoracic radiotherapy was allowed if necessary<br>|
| Experimental: TMZ group<br>Patients will receive platinum-based first-line chemotherapy according to the NCCN guidelines. The study will consist of 21-day cycles, to a maximum of 6 cyclesfor the first-line chemotherapy. After first-line treatment, temozolomide will be given alone as maintenance therapy in all patients who have achieved study entry hematologic criteria and who do not have progressive disease or severe toxicity. During temozolomide maintenance therapy, patients will receive temozolomide at 150mg/m2/d for 5 days of a 28-day cycle orally daily. Temozolomide maintenance therapy will continue until progressive disease or irreversible toxicity occurs. Re-staging will be performed every 2 cycles (every 8 weeks) during the study, radiotherapy was allowed. | Drug: Temozolomide<br>* Temozolomide is a nonclassic oral alkylating agent. Temozolomide will be given alone as maintenance therapy in patients who have achieved study entry hematologic criteria and who do not have progressive disease or severe toxicity. During temozolomide maintenance therapy, patients will receive temozolomide at 150mg/m2/d for 5 days of a 28-day cycle orally daily. Temozolomide maintenance therapy will continue until progressive disease or irreversible toxicity occurs.<br>Drug: first-line chemotherapy<br>* first-line chemotherapy must be platinum-based: cisplatin(75mg/m2 for d1) or carboplatin（AUC 5 for d1) combined with etoposide（100mg/m2 for d1-d3）<br>Radiation: Prophylactic cranial irradiation<br>* Prophylactic cranial irradiation was allowed if necessary<br>Radiation: thoracic radiotherapy<br>* thoracic radiotherapy was allowed if necessary<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| PFS of the maintenance therapy | from the data of randomized to the date of disease progression or the patient dies | 2 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| PFS | from the date of first-line chemotherapy to the date of disease progression | 2 years | 
| Number of participants with treatment-related adverse events as assessed by CTCAE v4.0 | Number of Participants with Adverse Events as a Measure of Safety and Tolerability | 2 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Small Cell Lung Carcinoma