Phase Ⅰ clinical trial of nimotuzumab in combination with concurrent chemo-radiotherapy in patients diagnosed with locally advanced non-small cell lung cancer
Abstract:Objective To observe the feasibility of nimotuzumab in combination with concurrent chemo-radiotherapy in locally-advanced non-small cell lung cancer (NSCLC). Methods From 2011 to 2012, Untreated stage ⅢA/ⅢB NSCLC patients were chosen and divided into three weekly dose level of nimotuzumab:100 mg, 200 mg and 400 mg,3—6 cases per group. If one of the first three patients experienced DLT, three additional patients were recruited to that dose level. If DLTs were observed in 50% patients in any cohort, dose escalation was stopped and that dose was designated the maximum tolerated dose. Intensity-modulated radiotherapy (IMRT) was taken, with total dose of 60—66 Gy in 30—33 fractions. Concurrent cisplantin and etoposide chemotherapy were performed. After concurrent treatment, consolidation weekly nimotuzumab treatment was performed until 16 weeks or disease progression observed. Assessment of efficacy and safety were performed via RECIST and CTC AE V3.0, respectively, maximum change in tumor volume and survival were calculated. Results Totally 9 cases enrolled. All three dose level were well tolerated, no dose-limiting toxicity observed. The most commonly reported severe adverse events were grade 3 hematological, including leucopenia (66%), neutropenia (66%), anemia (11%),and thrombocytopenia (22%). Most common non-hematological toxicity are esophagitis, grade 1(44%) or 2(22%), grade 1 radiation pneumonitis (44%), and grade 1 nausea/vomiting (44%). Mean total tumor volume decrease was 88%. With median survival of 26.4 months, the total 1 year and 2 year overall survival, disease free survival and progression free survival were 78% and 67%, 56% and 44%, 78% and 56%, respectively. Conclusion Weekly 100 mg, 200 mg and 400 mg nimotuzumab in combination with concurrent chemoradiotherapy can be well tolerated in locally advanced non-small cell lung cancer.
. Phase Ⅰ clinical trial of nimotuzumab in combination with concurrent chemo-radiotherapy in patients diagnosed with locally advanced non-small cell lung cancer[J]. Chinese Journal of Radiation Oncology, 2014, 23(3): 234-238.
[1] Baselga J. Why the epidermal growth factor receptor? The rationale for cancer therapy[J]. Oncologist,2002,7(Suppl 4):2-8. [2] Shepherd FA, Rodrigues PJ, Ciuleanu T, et al. Erlotinib in previously treated non-small-cell lung cancer[J]. N Engl J Med,2005,353:123-132. [3] Kim ES, Hirsh V, Mok T, et al. Gefitinib versus docetaxel in previously treated non-small-cell lung cancer (INTEREST):a randomized phase Ⅲ trial[J]. Lancet,2008,372:1809-1818. [4] Butts CA, Bodkin D, Middleman EL, et al. Randomized phase Ⅱ study of gemcitabine plus cisplatin or carboplatin with or without cetuximab, as first-line therapy for patients with advanced or metastatic non small-cell lung cancer[J]. J Clin Oncol,2007,25:5777-5784. [5] Brand TM, Iida M, Luthar N, et al. Nuclear EGFR as a molecular target in cancer[J]. Radiother Oncol,2013,108:370-377. [6] Dent P, Reardon DB, Park JS, et al. Radiation-induced release of transforming growth factor alpha activates the epidermal growth factor receptor and mitogen-activated protein kinase pathway in carcinoma cells, leading to increased proliferation and protection from radiation-induced cell death[J]. Mol Biol Cell,1999,10:2493-2506. [7] Huang SM, Bock JM, Harari PM. Epidermal growth factor receptor blockade with C225 modulates proliferation, apoptosis, and radiosensitivity in squamous cell carcinomas of the head and neck[J]. Cancer Res,1999,59:1935-1940. [8] Bebb G, Smith C, Rorke S, et al. Phase Ⅰ clinical trial of the anti-EGFR monoclonal antibody nimotuzumab with concurrent external thoracic radiotherapy in Canadian patients diagnosed with stage Ⅱb, Ⅲ or Ⅳ non-small cell lung cancer unsuitable for radical therapy[J]. Cancer Chemother Pharmacol,2011,67:837-845. [9] Choi HJ, Sohn JH, Lee CG, et al. A phase I study of nimotuzumab in combination with radiotherapy in stages ⅡB-Ⅳ non-small cell lung cancer unsuitable for radical therapy:Korean results[J]. Lung Cancer,2011,71:55-59. [10] Wang L, Wu S, Ou G, et al. Randomized phase Ⅱ study of concurrent cisplatin/etoposide or paclitaxel/carboplatin and thoracic radiotherapy in patients with stage Ⅲ non-small cell lung cancer[J]. Lung Cancer,2012,77:89-96. [11] Blumenschein GR, Paulus R, Curran WJ, et al. Phase Ⅱ study of cetuximab in combination with chemoradiation in patients with stage ⅢA/B non-small-cell lung cancer:RTOG0324[J]. J Clin Oncol,2011,29:2312-2318. [12] Therasse P, Arbuck SG, Eisenhauer EA, et al. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada[J]. J Natl Cancer Inst,2000,92:205-216. [13] Zhao KL, Hu XC, Wu XH, et al. A phase Ⅰ dose escalation study of Nimotuzumab in combination with concurrent chemoradiation for patients with locally advanced squamous cell carcinoma of esophagus[J]. Invest New Drugs,2012,30:1585-1590. [14] 黄晓东,易俊林,高黎,等.抗表皮生长因子受体单克隆抗体h-R3联合放疗治疗晚期鼻咽癌的Ⅱ期临床研究[J].中华肿瘤杂志,2007,29:197-201. [15] 汪洋,潘力,毛颖,等.尼妥珠单抗联合放疗加同期替莫唑胺治疗高分级胶质瘤的初步研究[J].中国癌症杂志,2009,19:836-860. [16] Strumberg D, Schultheis B, Scheulen ME, et al. Phase Ⅱ study of nimotuzumab, a humanized monoclonal anti-epidermal growth factor receptor (EGFR) antibody, in patients with locally advanced or metastatic pancreatic cancer[J]. Invest New Drugs,2012,30:1138-1143. [17] Curran W, Scott C, Langer C, et al. Phase Ⅲ comparison of Sequential vs concurrent chemoradiation for patients (Pts) with unresected stage Ⅲ non-small cell lung cancer (NSCLC):initial report of Radiation Therapy Oncology Group (RTOG) 9410[J]. Proc Am Soc Clin Oncol,2000,19:98. [18] Belani CP, Choy H, Bonomi P, et al. Combined chemoradiotherapy regimens of paclitaxel and carboplatin for locally advanced non-small-cell lung cancer:a randomized phase Ⅱ locally advanced multi-modality protocol[J]. J Clin Oncol,2005,23:5883-5891. [19] Crombet T, Osorio M, Cruz T, et al. Use of the humanized anti-epidermal growth factor receptor monoclonal antibody h-R3 in combination with radiotherapy in the treatment of locally advalced head and nick cancer patients[J]. J Clin Oncol,2004,11:1646-1654.