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Goss GD, Arnold A, Shepherd FA, Dediu M, Ciuleanu TE, Fenton D, Zukin M, Walde D, Laberge F, Vincent MD, Ellis PM, Laurie SA, Ding K, Frymire E, Gauthier I, Leighl NB, Ho C, Noble J, Lee CW, Seymour L. Randomized, double-blind trial of carboplatin and paclitaxel with either daily oral cediranib or placebo in advanced non-small-cell lung cancer: NCIC clinical trials group BR24 study. J Clin Oncol 2009; 28:49-55. [PMID: 19917841 DOI: 10.1200/jco.2009.22.9427] [Citation(s) in RCA: 196] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE This phase II/III double-blind study assessed efficacy and safety of cediranib with standard chemotherapy as initial therapy for advanced non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS Paclitaxel (200 mg/m(2)) and carboplatin (area under the serum concentration-time curve 6) were given every 3 weeks, with daily oral cediranib or placebo at 30 mg (first 45 patients received 45 mg). Progression-free survival (PFS) was the primary outcome of the phase II interim analysis; phase III would proceed if the hazard ratio (HR) for PFS < or = 0.77 and toxicity were acceptable. Results A total of 296 patients were enrolled, 251 to the 30-mg cohort. The phase II interim analysis demonstrated a significantly higher response rate (RR) for cediranib than for placebo, HR of 0.77 for PFS, no excess hemoptysis, and a similar number of deaths in each arm. The study was halted to review imbalances in assigned causes of death. In the primary phase II analysis (30-mg cohort), the adjusted HR for PFS was 0.77 (95% CI, 0.56 to 1.08) with a higher RR for cediranib than for placebo (38% v 16%; P < .0001). Cediranib patients had more hypertension, hypothyroidism, hand-foot syndrome, and GI toxicity. Hypoalbuminemia, age > or = 65 years, and female sex predicted increased toxicity. Survival update (N = 296) 10 months after study unblinding favored cediranib over placebo (median of 10.5 months v 10.1 months; HR, 0.78; 95% CI, 0.57 to 1.06; P = .11). Causes of death in the cediranib 30-mg cohort were NSCLC (81%), protocol toxicity +/- NSCLC (13%), and other (6%); for the placebo group, they were 98%, 0%, and 2%, respectively. CONCLUSION The addition of cediranib to carboplatin/paclitaxel results in improved response and PFS, but does not appear tolerable at a 30-mg dose. Consequently, the National Cancer Institute of Canada Clinical Trials Group and the Australasian Lung Cancer Trials Group initiated a randomized, double-blind, placebo-controlled trial of cediranib 20 mg with carboplatin and paclitaxel in advanced NSCLC.
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Affiliation(s)
- Glenwood D Goss
- FCP(SA), FRCPC, The Ottawa Hospital Cancer Centre, 501 Smyth Rd, Ottawa ON K1H 8L6, Canada.
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Laurie SA, Gauthier I, Arnold A, Shepherd FA, Ellis PM, Chen E, Goss G, Powers J, Walsh W, Tu D, Robertson J, Puchalski TA, Seymour L. Phase I and Pharmacokinetic Study of Daily Oral AZD2171, an Inhibitor of Vascular Endothelial Growth Factor Tyrosine Kinases, in Combination With Carboplatin and Paclitaxel in Patients With Advanced Non–Small-Cell Lung Cancer: The National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol 2008; 26:1871-8. [DOI: 10.1200/jco.2007.14.4741] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
PurposeAZD2171 is a potent inhibitor of vascular endothelial growth factor receptors that showed broad antitumor activity in preclinical models. Doses of up to 45 mg/d of AZD2171 are tolerable when administered alone. This study evaluated escalating doses of AZD2171 in combination with standard chemotherapy in patients with advanced non–small-cell lung cancer.Patients and MethodsEligible patients received carboplatin targeted to an area under the concentration time curve of 6 mg · min/mL and paclitaxel 200 mg/m2, both on day 1 of a 3-week cycle; daily oral AZD2171 at either 30 mg or 45 mg commenced day 2 of cycle 1. Pharmacokinetics of all drugs were performed, and tumor response was assessed by Response Evaluation Criteria in Solid Tumors (RECIST).ResultsTwenty patients were enrolled. No dose-limiting toxicities were observed during cycle 1 at either dose. Fatigue, diarrhea, anorexia, and granulocytopenia were common; hypertension was manageable with a treatment algorithm designed for this protocol. No clinically significant drug-related bleeding was observed. At 45 mg/d, fatigue and diarrhea were increased, and headache and hoarseness were observed. Paclitaxel clearance decreased during cycle 2, but no other significant pharmacokinetic interactions were observed. After radiology review, confirmed responses were observed in nine patients (response rate, 45%; 95% CI, 23% to 68%); all but one enrolled patient showed evidence of tumor shrinkage, some with cavitation.ConclusionAZD2171 can be combined with standard doses of carboplatin/paclitaxel with encouraging antitumor activity. Toxicity is increased, but predictable and manageable.
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Affiliation(s)
- Scott A. Laurie
- From the From the Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa; Juravinski Cancer Centre, McMaster University, Hamilton; Princess Margaret Hospital, University of Toronto, Toronto; National Cancer Institute of Canada Clinical Trials Group, Queen's University, Kingston, Ontario, Canada; and AstraZeneca, Macclesfield, United Kingdom
| | - Isabelle Gauthier
- From the From the Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa; Juravinski Cancer Centre, McMaster University, Hamilton; Princess Margaret Hospital, University of Toronto, Toronto; National Cancer Institute of Canada Clinical Trials Group, Queen's University, Kingston, Ontario, Canada; and AstraZeneca, Macclesfield, United Kingdom
| | - Andrew Arnold
- From the From the Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa; Juravinski Cancer Centre, McMaster University, Hamilton; Princess Margaret Hospital, University of Toronto, Toronto; National Cancer Institute of Canada Clinical Trials Group, Queen's University, Kingston, Ontario, Canada; and AstraZeneca, Macclesfield, United Kingdom
| | - Frances A. Shepherd
- From the From the Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa; Juravinski Cancer Centre, McMaster University, Hamilton; Princess Margaret Hospital, University of Toronto, Toronto; National Cancer Institute of Canada Clinical Trials Group, Queen's University, Kingston, Ontario, Canada; and AstraZeneca, Macclesfield, United Kingdom
| | - Peter M. Ellis
- From the From the Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa; Juravinski Cancer Centre, McMaster University, Hamilton; Princess Margaret Hospital, University of Toronto, Toronto; National Cancer Institute of Canada Clinical Trials Group, Queen's University, Kingston, Ontario, Canada; and AstraZeneca, Macclesfield, United Kingdom
| | - Eric Chen
- From the From the Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa; Juravinski Cancer Centre, McMaster University, Hamilton; Princess Margaret Hospital, University of Toronto, Toronto; National Cancer Institute of Canada Clinical Trials Group, Queen's University, Kingston, Ontario, Canada; and AstraZeneca, Macclesfield, United Kingdom
| | - Glenwood Goss
- From the From the Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa; Juravinski Cancer Centre, McMaster University, Hamilton; Princess Margaret Hospital, University of Toronto, Toronto; National Cancer Institute of Canada Clinical Trials Group, Queen's University, Kingston, Ontario, Canada; and AstraZeneca, Macclesfield, United Kingdom
| | - Jean Powers
- From the From the Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa; Juravinski Cancer Centre, McMaster University, Hamilton; Princess Margaret Hospital, University of Toronto, Toronto; National Cancer Institute of Canada Clinical Trials Group, Queen's University, Kingston, Ontario, Canada; and AstraZeneca, Macclesfield, United Kingdom
| | - Wendy Walsh
- From the From the Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa; Juravinski Cancer Centre, McMaster University, Hamilton; Princess Margaret Hospital, University of Toronto, Toronto; National Cancer Institute of Canada Clinical Trials Group, Queen's University, Kingston, Ontario, Canada; and AstraZeneca, Macclesfield, United Kingdom
| | - Dongsheng Tu
- From the From the Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa; Juravinski Cancer Centre, McMaster University, Hamilton; Princess Margaret Hospital, University of Toronto, Toronto; National Cancer Institute of Canada Clinical Trials Group, Queen's University, Kingston, Ontario, Canada; and AstraZeneca, Macclesfield, United Kingdom
| | - Jane Robertson
- From the From the Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa; Juravinski Cancer Centre, McMaster University, Hamilton; Princess Margaret Hospital, University of Toronto, Toronto; National Cancer Institute of Canada Clinical Trials Group, Queen's University, Kingston, Ontario, Canada; and AstraZeneca, Macclesfield, United Kingdom
| | - Thomas A. Puchalski
- From the From the Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa; Juravinski Cancer Centre, McMaster University, Hamilton; Princess Margaret Hospital, University of Toronto, Toronto; National Cancer Institute of Canada Clinical Trials Group, Queen's University, Kingston, Ontario, Canada; and AstraZeneca, Macclesfield, United Kingdom
| | - Lesley Seymour
- From the From the Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa; Juravinski Cancer Centre, McMaster University, Hamilton; Princess Margaret Hospital, University of Toronto, Toronto; National Cancer Institute of Canada Clinical Trials Group, Queen's University, Kingston, Ontario, Canada; and AstraZeneca, Macclesfield, United Kingdom
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