An open label phase II trial of the Plk1 inhibitor BI 2536, in patients with sensitive relapse small cell lung cancer (SCLC)

8108

Background: BI 2536 is a potent, selective inhibitor of polo-like kinase 1 (Plk1), a regulator of mitotic progression. BI 2536 demonstrated favorable tolerability and antitumor activity in phase I trials. We investigated the antitumor efficacy, safety and PK of BI 2536 in patients (pts) with sensitive relapse SCLC. Methods: This open label single arm phase II study followed a Gehan two-stage design. Primary objective was to determine the antitumor efficacy of BI 2536 in SCLC pts with disease recurrence ≥60 days after completion of first-line chemotherapy. 18 pts had to complete 2 courses to be evaluable for stage 1 analysis. In case of ≥2 partial or complete antitumor responses (RECIST criteria), stage 2 accrual would continue until 40 pts were entered. Patients received 200 mg BI 2536 as a 1h i.v. infusion on Day 1 every 3 weeks. Dose escalation to 250 mg (cycle 3 onwards) was encouraged in pts with <Grade 2 drug related non-hematologic and <Grade 3 hematologic toxicity. Results: 23 pts (14 female, 9 male, 21 extensive disease, 2 limited disease), median age 60 yrs (range: 35–77) were treated. All patients had disease recurrence >60 days after completion of first-line therapy. Of 23 pts, no objective antitumor responses were observed, 7 had stable disease as best response, 14 had progression, 2 were not evaluable. A median of 2 courses were given, up to a maximum of 12 in 1 pt. The PFS rate at 3 months was 25%. Due to the lack of antitumor responses, trial accrual was terminated after stage 1. Overall, BI 2536 was well tolerated. Frequent AEs were neutropenia (48%), fatigue (39%), nausea (30%), anemia, vomiting, constipation (26% each), and thrombocytopenia (22%). Drug related grade 3/4 AEs were neutropenia (13%/26%), grade 3/4 thrombocytopenia (1 pt each), grade 3/4 anemia (1 pt each), grade 4 sepsis (1 pt), Grade 4 ARDS (1 pt) and Grade 3 fatigue (1 pt). PK analyses indicate that BI 2536 has high clearance (>1,000 mL/min) and quickly distributes in multiple compartments in a large volume of distribution (>1,000 L). Estimated elimination half-life was >25 h. Conclusions: BI 2536 was well tolerated in relapsed SCLC pts, but demonstrated no convincing antitumor efficacy after stage I of the study. Therefore, BI 2536 will not be assessed further as a single agent in SCLC.

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Prognostic significance of tumor size in patients with stage III non-small cell lung cancer: A SEER database survey

7529

Background: Although tumor size is a known predictor of stage I and II non-small cell lung cancer (NSCLC) treated with surgery or radiotherapy, there is limited information regarding its prognostic significance in patients with mediastinal lymph node involvement. Methods: The Surveillance Epidemiology and End Results (SEER) registry was queried for patients with unresected NSCLC stage III, without malignant pleural effusion, aged 21 or older, and diagnosed between 1998 and 2003. Tumor size was defined as S1 (0.1–3 cm), S2 (3.1–5 cm), S3 (5.1–7 cm) and S4 (7.1–20 cm). Demographic variables included age, gender, race and histology. The Kaplan-Meier method was used to estimate the overall survival (OS) and disease-specific survival (DSS), and the Cox proportional hazard model to evaluate whether tumor size remained an independent risk factor after adjusting for stage and other demographic variables. Results: A total of 12,205 patients met the eligibility criteria. Median age at diagnosis was 70 years and most patients were male (58.8%) and white (81.3%). Tumor size was a statistically significant predictor for both overall survival (p<0.0001) and disease-specific survival (p<0.0001) on multivariate analysis. Selected groups of patients with smaller stage IIIB disease had better OS compared to patients with stage IIIA, including; IIIBS1 vs. IIIAS3 (p=0.0005) or IIIA S4 (p<0.0001) and IIIBS2 vs. IIIAS4 (p=0.0001). Conclusions: Tumor size is an independent predictor for OS and DSS in patients with unresected stage III NSCLC and should be considered in the stratification of patients treated in this setting.

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No significant financial relationships to disclose.

Improving survival for metastatic non-small cell lung cancer: A SEER database analysis from 1990 to 2005

8078

Background: Treatment of metastatic non-small cell lung cancer (NSCLC) has evolved over the last decade with the increased use of third-generation chemotherapy agents, established benefits from second-line chemotherapy, and the development of targeted agents. We conducted a study to evaluate whether these treatment advances translated into improved survival in a large registry database. Methods: The Surveillance Epidemiology and End Results (SEER) registry was queried for patients with NSCLC stage IV, aged 21 or older, and diagnosed between 1990 and 2005. Overall Survival (OS) rates were estimated by the Kaplan-Meier method and compared using log-rank test. Cox proportional hazard model was fitted to evaluate whether the diagnostic period is an independent predictor for OS. Demographic variables included period of diagnosis (1990–1993 or P1, 1994–1997 or P2, 1998–2001 or P3, and 2002–2005 or P4), age, gender, race, and histology. Results: There were 127,816 patients meeting eligibility criteria. Median age at presentation was 67 and most patients were male (58%), white (81%), and had adenocarcinoma (39%). Although there was no significant differences in OS between periods 1 and 2 (p = 0.18), there was a significant improvement from periods 2 to 3 (p < 0.001) and 3 to 4 (p < 0.001). 1-y and 2-y OS increased from 13.2% and 4.5% respectively in P1 to 19.4% and 7.8% respectively in P4. Predictive factors for improved survival in multivariate analyses included diagnostic period (p < 0.001), younger age (p < 0.0001), female gender (p < 0.0001), and non-black race (p < 0.0001). After adjusting for demographic factors, there were no significant differences in OS between adenocarcinoma and squamous cell from P1 to P3 (1990–2001). However, P4 showed a significant increase in OS for adenocarcinoma compared with squamous cell (p = 0.02). Conclusions: There has been a significant improvement in OS for stage IV NSCLC over the last 8 years. The recent differences in outcomes based on histology observed in P4 may reflect the increased activity of newer therapies in adenocarcinoma compared with squamous cell, including gefitinib and erlotinib.

No significant financial relationships to disclose.

Phase II study of pemetrexed, carboplatin, and thoracic radiation with or without cetuximab in patients with locally advanced unresectable non-small cell lung cancer: CALGB 30407

7505

Background: Cisplatin, etoposide and concurrent thoracic radiation has remained the standard treatment for locally advanced unresectable non small cell lung cancer (NSCLC) over the past two decades. The Cancer and Leukemia Group B (CALGB) conducted a phase II study using a novel chemotherapy regimen administered in systemically active doses with thoracic radiation (CALGB 30407). We previously reported the preliminary safety results (ASCO 2008, abstract 7518). Methods: Eligible patients with previously untreated stage III NSCLC received thoracic radiation (70 Gy) along with carboplatin (AUC 5) and pemetrexed 500 mg/m2 on day 1 administered intravenously every 21 days for 4 cycles (arm A) or the same chemotherapy regimen with weekly cetuximab for 6 weeks concurrent with radiation (arm B). All patients received four additional cycles of pemetrexed (500 mg/m2 every 21 days) as consolidation therapy. The primary endpoint was the percentage of patients who lived longer than 18 months after starting initial treatment. We planned to study the regimen (s) further if the 18 month survival rates equaled or exceeded 55%. Results: Characteristics of the 99 eligible pts (48 in arm A and 51 arm B) enrolled from 09/05 to 1/08: male 62%, 22% were 70 yrs or older. The most common histological type was adenocarcinoma (46% in Arm A and 41% in Arm B). Updated toxicity data (grade 3 or greater, %) by arms (arm A/arm B) for 106 pts: neutropenia 40/47; febrile neutropenia 8/6, thrombocytopenia 36/34, nausea/vomiting 8/10, esophagitis 32/24, skin rash 2/21 and fatigue 22/17. The median follow up time is 17 months. Preliminary efficacy data by arms (arm A/arm B) for 99 pts: complete or partial response 73% (95% CI 59–83)/71% (95% CI 57–81%), median failure free survival (months) 12.9 (95% CI 8.6–18.0)/10.3 (95% CI 8.7–18.9); 18 month survival 57% (95% CI 41–79)/47% (95% CI 33–67) and median survival (months) 22.3/18.7. Conclusions: The combination of pemetrexed, carboplatin and thoracic radiation has met the protocol-specified criteria for further study. Although it does not appear that the addition of cetuximab confers additional benefit in this setting, further follow-up is necessary.

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An analysis of elderly patients (pts) treated on a phase III trial of cisplatin (P) plus etoposide (E) with concurrent radiotherapy (CRT) followed by docetaxel (D) vs observation (O) in pts with stage III non small cell lung cancer (NSCLC)

9037

Background: Concurrent CRT is standard treatment for pts with unresectable stage III NSCLC. HOG LUN01–24 is a phase III trial testing if consolidation D improves survival following EP/XRT. Few data are available on outcomes in elderly pts. We performed a subset analysis to determine the efficacy & tolerability of EP/XRT & consolidation D in elderly pts (≥70 yrs) vs younger (<70) pts. Methods: Patient (n=203), disease characteristics, survival & toxicity were compared for pts age ≥70 (n=52) vs <70 (n=151). Results: Median age for elderly was 73 vs 60 for younger pts. 34% of each group were women. Younger pts had a trend towards PS 0 (61% vs 53% elderly), FEV-1 > 2 L (48% vs 43% elderly), stage IIIB disease (61% vs 53% elderly). Younger pts were more likely to be current smokers (51% vs 15% elderly). 74% of younger pts were randomized vs 67% of elderly. During EP/XRT, elderly pts were more likely to discontinue treatment due to toxicity (12% vs 2%) & require hospitalization (40% vs 28%). Selected G3/4 toxicities during EP/XRT in elderly vs younger pts: neutropenia (42 vs 28%), anemia (9 vs 5%), febrile neutropenia (FN) (6 vs 11%), esophagitis (23 vs 15%), dehydration (15 vs 7%). Elderly pts were less likely to complete 3 cycles of consolidation D (76 vs 84%). Selected G 3/4 toxicities during consolidation D were similar between elderly (n=18) and younger pts (n=55), including FN (11.1 vs 10.9%). There was no difference in MST for older pts vs younger pts (17.2 vs 21.2 mos), p=0.3255. Conclusion: Chemoradiation is associated with higher rates of G 3/4 toxicities in elderly pts, including hospitalization rates. Elderly pts had lower rates of completing D, but similar incidence of D-related toxicity. There was no difference in MST between the age groups.

No significant financial relationships to disclose.

Phase III trial of cisplatin (P) plus etoposide (E) plus concurrent chest radiation (XRT) with or without consolidation docetaxel (D) in patients (pts) with inoperable stage III non-small cell lung cancer (NSCLC): HOG LUN 01–24/USO-023

7512

Background: Concurrent chemoradiation is standard treatment for pts with inoperable stage III NSCLC. A previously reported single-arm, phase II study by SWOG (Gandara et al JCO 2003) suggested D following EP/XRT further improved survival. We report results from a randomized, prospective phase III trial comparing EP/XRT with or without consolidation D. Methods: Eligible pts had inoperable, stage IIIA/B NSCLC, PS 0–1, FEV-1 ≥ 1 L, and < 5% wt loss. Pts (n=243) received P 50 mg/m2 iv d 1,8,29,36 and E 50 mg/m2 iv d1–5, 29–33 concurrently with chest XRT to 5940 cGy. Non-progressing pts were randomized to D 75 mg/m2 iv every 21 d for 3 cycles vs observation (O). The primary endpoint was to compare OS (Kaplan-Meier analysis). Accrual of 259 pts to randomize180 was planned to demonstrate a difference in MST of 25 vs 15 mos (5% 2-sided alpha, 80% power). Based upon evidence of futility (predefined as p>0.7271), a DSMB recommended early termination after an analysis of the initial 203 pts. Results: Median f/u 25.6 mos. Pt characteristics (n=203): 34%/66% F:M; median age 63; 39.4%/60.6% IIIA/B. G3/4 toxicities during EP/XRT included 9.8% febrile neutropenia (FN), 17.2% esophagitis. 147 of 203 pts (72.4%) were randomized to D (n=73) or O (n=74). G3/4 toxicities during D included: 10.9% FN, 8.2% pneumonitis. 28.8% of pts were hospitalized during D (vs 8.1% in O arm) and 5.5% died due to D. PFS for D was 12.3 vs 12.9 mos for O (p=0.9412). The MST for all pts was 21.15 mos; MST for D was 21.6 mos (95% C.I. 17.7–35) vs 24.2 mos for O (95% C.I. 18.1–34.4) (p=0.9402). Conclusions: The MST with EP/XRT was higher than historical controls; however, consolidation D does not further improve survival, is associated with significant toxicity including an increased rate of hospitalization and premature death, and should no longer be used for pts with unresectable stage III NSCLC.

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Activity of patupilone for the treatment of recurrent or progressive brain metastases in patients (pts) with non-small cell lung cancer (NSCLC): An open-label, multicenter, phase II study

18058

Background: Advances in systemic chemotherapy have improved overall survival for patients with advanced NSCLC; unfortunately, CNS metastasis is common and limits survival benefits with current therapies. Unlike taxanes, preclinical findings suggest that the novel epothilone, patupilone, crosses the blood-brain barrier in 3 animal species and also has antitumor effects in brain tumor models. Results of an ongoing phase I/II study of patupilone as second-line therapy in pts with NSCLC are encouraging. The present study is evaluating the efficacy of patupilone in pts with brain metastases from NSCLC who have failed or recurred after previous chemotherapy, surgery, and/or radiation to the brain. Methods: This open-label, single-arm, multicenter, phase II study has a 2-stage design (25 pts per stage). Eligible pts have histologically confirmed NSCLC and = 1 recurrent, bidimensionally measurable intracranial lesion = 2 cm. Patupilone was administered IV at 10 mg/m2 as a single 20-min IV infusion every 3 weeks until disease progression, satisfactory response, or unacceptable toxicity. The primary multinomial endpoint was a combination of early progression (disease progression or death before cycle 1, day 21) and response rate (alive without progression at cycle 4, day 1). Results: An interim analysis of 13 pts with a median age of 62 years (range, 40–67 years) is reported. The most common adverse events (AEs) related to study drug were NCI CTC grade 1/2 diarrhea in 7 (54%) pts, nausea in 3 (23%), and fatigue in 2 (15%). Only 2 serious AEs (grade 4 colitis and grade 3 diarrhea) and 2 additional grade 3 AEs (diarrhea, neutropenia) were reported in 1 pt each. Three (23%) pts experienced early disease progression. Five (38%) pts responded, receiving a median 10 cycles (range, 5 to 12 cycles) and were alive without progression on cycle 4, day 1. Conclusions: Patupilone has activity in patients with CNS metastases from advanced NSCLC and is well tolerated. Additional investigation of patupilone as a treatment for brain metastases from NSCLC is warranted.

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Trends in stage distribution for patients with non-small cell lung cancer: A National Cancer Database Survey

7598

Background: We have previously reported a significant change in stage distribution for non-small cell lung cancer (NSCLC) among patients diagnosed at our institution (ASCO 2006 # 7205). To confirm this observation, a larger sample population was evaluated. Methods: Patients with NSCLC registered at the National Cancer Database (NCDB) and diagnosed between the years 1998 and 2003 were evaluated for demographic characteristics including age, race, gender, and stage at presentation. Results: 551,248 patients were identified. Patients with stage 0 or unknown stage were excluded from the study, leaving 510,942 eligible for the final analysis. The annual proportions of stage IV disease at the time of diagnosis are described in the table below. Stage distribution remained stable from 1998 to 2000, but a sharp increase in the percentage of stage IV was noticed between 2000 and 2001 (35.7% to 38.9%). This increase in the percentage of stage IV patients was sustained in the subsequent years and present across the other demographic variables. Conclusions: We have documented a significant change in the NSCLC stage distribution over the last six years. The NCDB is the largest database available and currently captures approximately 62% of all NSCLC patients diagnosed in the United States. The increase in stage IV disease coincides with the widespread adoption of FDG-PET, suggesting an earlier diagnosis of metastatic disease and confirming our previous findings.

No significant financial relationships to disclose.

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