Description:
This phase III ALCHEMIST trial studies how well erlotinib hydrochloride compared to
observation works in treating patients with stage IB-IIIA non-small cell lung cancer that has
been completely removed by surgery (resected). Erlotinib hydrochloride may stop the growth of
tumor cells by blocking some of the enzymes needed for cell growth.
Title
- Brief Title: Erlotinib Hydrochloride in Treating Patients With Stage IB-IIIA Non-small Cell Lung Cancer That Has Been Completely Removed by Surgery (An ALCHEMIST Treatment Trial)
- Official Title: Randomized Study of Erlotinib vs Observation in Patients With Completely Resected Epidermal Growth Factor Receptor (EGFR) Mutant Non-Small Cell Lung Cancer (NSCLC)
Clinical Trial IDs
- ORG STUDY ID:
NCI-2014-01508
- SECONDARY ID:
NCI-2014-01508
- SECONDARY ID:
s16-02079
- SECONDARY ID:
CALGB A081105
- SECONDARY ID:
A081105
- SECONDARY ID:
A081105
- SECONDARY ID:
U10CA180821
- SECONDARY ID:
U10CA180830
- SECONDARY ID:
U10CA031946
- NCT ID:
NCT02193282
Conditions
- Lung Non-Squamous Non-Small Cell Carcinoma
- Stage IB Lung Non-Small Cell Carcinoma AJCC v7
- Stage II Lung Non-Small Cell Cancer AJCC v7
- Stage IIA Lung Non-Small Cell Carcinoma AJCC v7
- Stage IIB Lung Non-Small Cell Carcinoma AJCC v7
- Stage IIIA Lung Non-Small Cell Cancer AJCC v7
Interventions
Drug | Synonyms | Arms |
---|
Erlotinib Hydrochloride | Cp-358,774, OSI-774, Tarceva | Arm A (blinded erlotinib hydrochloride) |
Purpose
This phase III ALCHEMIST trial studies how well erlotinib hydrochloride compared to
observation works in treating patients with stage IB-IIIA non-small cell lung cancer that has
been completely removed by surgery (resected). Erlotinib hydrochloride may stop the growth of
tumor cells by blocking some of the enzymes needed for cell growth.
Detailed Description
PRIMARY OBJECTIVE:
I. To assess whether adjuvant therapy with erlotinib hydrochloride (erlotinib) will result in
improved overall survival (OS) over observation for patients with completely resected stage
IB (>= 4 cm)-IIIA epidermal growth factor receptor (EGFR) mutant non-small cell lung cancer
(NSCLC) (confirmed centrally) following complete resection and standard post-operative
therapy.
SECONDARY OBJECTIVES:
I. To assess whether adjuvant therapy with erlotinib will result in improved disease free
survival (DFS) over observation for patients with completely resected stage IB (>= 4 cm)-IIIA
EGFR mutant NSCLC (confirmed centrally) following complete resection and standard
post-operative therapy, both overall and within the stage subgroups: IB and II/IIIA.
II. To evaluate the safety profile of erlotinib in the adjuvant setting. III. To assess
whether adjuvant therapy with erlotinib will result in improved DFS rate at 2 years, and OS
rate at 5 and 10 years over observation for patients with completely resected stage IB (>= 4
cm)-IIIA EGFR mutant NSCLC (confirmed centrally) following complete resection and standard
post-operative therapy, both overall and within the stage subgroups: IB and II/IIIA.
IV. To assess the primary and secondary objectives in all randomized patients, regardless of
central confirmation of the EGFR mutant status.
V. To study detection of circulating EGFR mutations in cell-free plasma deoxyribonucleic acid
(DNA) as a prognostic marker in resected early stage NSCLC.
OUTLINE: Patients are randomized to 1 of 4 treatment arms.
ARM A (BLINDED ERLOTINIB- CLOSED 06/14/17): Blinded patients receive erlotinib hydrochloride
orally (PO) once daily (QD) on days 1-21. Treatment repeats every 21 days for up to 2 years
in the absence of disease progression or unacceptable toxicity.
ARM B (PLACEBO- CLOSED 06/14/17): Patients receive placebo PO QD on days 1-21. Treatment
repeats every 21 days for up to 2 years in the absence of disease progression or unacceptable
toxicity.
ARM C (UNBLINDED ERLOTINIB): Unblinded patients receive erlotinib hydrochloride PO QD on days
1-21. Treatment repeats every 21 days for up to 2 years in the absence of disease progression
or unacceptable toxicity.
ARM D (OBSERVATION): Patients (including patients previously randomized to placebo) undergo
observation at least every 6 months for 2 years.
After completion of study treatment, patients are followed up every 6 months for 4 years and
then yearly for 6 years.
Trial Arms
Name | Type | Description | Interventions |
---|
Arm A (blinded erlotinib hydrochloride) | Experimental | Blinded patients receive erlotinib hydrochloride PO QD on days 1-21. Treatment repeats every 21 days for up to 2 years in the absence of disease progression or unacceptable toxicity. (CLOSED 06/14/17) | |
Arm B (placebo) | Placebo Comparator | Patients receive placebo PO QD on days 1-21. Treatment repeats every 21 days for up to 2 years in the absence of disease progression or unacceptable toxicity. (CLOSED 06/14/17) | |
Arm C (unblinded erlotinib hydrochloride) | Experimental | Unblinded patients receive erlotinib hydrochloride PO QD on days 1-21. Treatment repeats every 21 days for up to 2 years in the absence of disease progression or unacceptable toxicity. | |
Arm D (observation) | Active Comparator | Patients (including patients previously randomized to placebo) undergo observation at least every 6 months for 2 years. | |
Eligibility Criteria
Inclusion Criteria:
- Previously registered to A151216, with the result of lung cancer harboring an EGFR
exon 19 deletion or L858R mutation; the testing must have been performed by one of the
following criteria:
1. Patient registered to A151216 and the assessment performed centrally by the
protocol-specified laboratory
2. By a local Clinical Laboratory Improvement Amendments (CLIA) certified
laboratory; the report must indicate the result as well as the CLIA number of the
laboratory that performed the assay; these patients will also have been
registered to A151216, but can be enrolled on A081105 regardless of the central
lab results
- Patients with known resistant mutations in the EGFR tyrosine-kinase (TK)
domain (T790M) are not eligible
- Patients that are both EGFR mutant and anaplastic lymphoma kinase (ALK)
rearrangements will be registered to A081105
- Completely resected stage IB (>= 4 cm), II or IIIA non-squamous NSCLC with negative
margins; patients may not have received neoadjuvant therapy (chemo- or radio-therapy)
for this lung cancer
- Complete recovery from surgery and standard post-operative therapy (if required);
patients must be completely recovered from surgery at the time of randomization; the
minimum time requirement between date of surgery and randomization must be at least 28
days, the maximum time requirement between surgery and randomization must be 90 days
if no adjuvant chemotherapy was administered, 240 days if adjuvant chemotherapy was
administered, and 300 days if adjuvant chemotherapy and radiation therapy was
administered
- Eastern Cooperative Oncology Group (ECOG) performance status 0-1
- No locally advanced or metastatic cancer requiring systemic therapy within 5 years
prior to registration; no secondary primary lung cancer diagnosed concurrently or
within 2 years prior to registration
- Non-pregnant and non-lactating
- No history of cornea abnormalities
- Granulocytes >= 1,500/ul
- Platelets >= 100,000/ul
- Total bilirubin =< 1.5 x upper limit of normal (ULN)
- Serum glutamic oxaloacetic transaminase (SGOT) =< 1.5 x ULN
- Serum creatinine =< 1.5 x ULN
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Overall survival (OS) |
Time Frame: | The time from randomization until death, assessed up to 10 years |
Safety Issue: | |
Description: | Estimated using the method of Kaplan-Meier survival curves and a 1-sided stratified log rank test (accounting for all the stratification factors) will be used to compare OS between the two arms. Cox proportional hazards model (including time varying coefficients as necessary) will be used to assess whether the distribution of OS times differ with respect to treatment regimen after having adjusted for the stratification factors as well as other potential prognostic and treatment covariates. |
Secondary Outcome Measures
Measure: | Disease free survival (DFS) rate |
Time Frame: | Time from randomization until documented disease-recurrence or death, whichever occurs first, assessed at 2 years |
Safety Issue: | |
Description: | DFS will be defined as the proportion of patients alive and disease free at 2 years from the date of randomization. Estimated using the method of Kaplan-Meier survival curves. A 1-sided stratified log rank test (accounting for all the stratification factors) will be used to compare DFS between the arms, as well as to compare DFS and OS between the arms within the stage groups. Cox proportional hazards model (including time varying coefficients as necessary) will be used to assess potential differences in time to event outcomes after adjusting for the stratification factors and other potential prognostic and treatment covariates. |
Measure: | Overall survival (OS) rate at 5 years |
Time Frame: | At 5 years |
Safety Issue: | |
Description: | Will be defined as the proportion of patients alive at 5 years from date of randomization. Estimated using the method of Kaplan-Meier survival curves. A 1-sided stratified log rank test (accounting for all the stratification factors) will be used to compare DFS between the arms, as well as to compare DFS and OS between the arms within the stage groups. Cox proportional hazards model (including time varying coefficients as necessary) will be used to assess potential differences in time to event outcomes after adjusting for the stratification factors and other potential prognostic and treatment covariates. |
Measure: | Overall survival (OS) rate at 10 years |
Time Frame: | At 10 years |
Safety Issue: | |
Description: | Will be defined as the proportion of patients alive at 10 years from date of randomization. Estimated using the method of Kaplan-Meier survival curves. A 1-sided stratified log rank test [accounting for all the stratification factors] will be used to compare DFS and OS between the arms within the stage groups. Cox proportional hazards model (including time varying coefficients as necessary) will be used to assess potential differences in time to event outcomes after adjusting for the stratification factors and other potential prognostic and treatment covariates. |
Measure: | Overall disease free survival (DFS) between the erlotinib hydrochloride and observation arms |
Time Frame: | Time from randomization until documented disease-recurrence or death, whichever occurs first, assessed up to 10 years |
Safety Issue: | |
Description: | Estimated using the method of Kaplan-Meier survival curves (21). A 1-sided stratified log rank test [accounting for all the stratification factors] will be used to compare DFS between the arms, as well as to compare DFS and OS between the arms within the stage groups. Cox proportional hazards model (including time varying coefficients as necessary) will be used to assess potential differences in time to event outcomes after adjusting for the stratification factors and other potential prognostic and treatment covariates. |
Measure: | Incidence of adverse events associated with each treatment arm |
Time Frame: | Up to 10 years |
Safety Issue: | |
Description: | The maximum grade for each type of adverse event will be recorded for each patient and frequency tables will be reviewed to determine the overall patterns. The number and severity of grade 3 + adverse events will be tabulated and summarized. All adverse events analysis will entail comparisons between the arms within Arms A and B, respectively. Analysis of the overall adverse event rates, as well as specific events of interest will involve chi-square tests or Fisher's exact tests. |
Details
Phase: | Phase 3 |
Primary Purpose: | Interventional |
Overall Status: | Active, not recruiting |
Lead Sponsor: | National Cancer Institute (NCI) |
Last Updated
August 27, 2021