Clinical Trials /

Inhibition of CArbonic Anhydrase in Combination With Platinum and Etoposide-based Radiochemotherapy in Patients With Localized Small Cell Lung Cancer

NCT03467360

Description:

The investigators propose to study the carbonic anhydrase inhibition (acetazolamide) associated with concomitant radiochemotherapy in localized small cell lung cancer due to: 1. The over-expression of carbonic anhydrases in this type of cancer, 2. The Anti-tumor effect in preclinical acetazolamide in various tumor lines including neuroendocrine tumor lines, 3. The observed synergy between irradiation and inhibition of carbonic anhydrases, 4. Potential anti-tumor immune effect caused by decreased extracellular acidity.

Related Conditions:
  • Small Cell Lung Carcinoma
Recruiting Status:

Recruiting

Phase:

Phase 1

Trial Eligibility

Document

Title

  • Brief Title: Inhibition of CArbonic Anhydrase in Combination With Platinum and Etoposide-based Radiochemotherapy in Patients With Localized Small Cell Lung Cancer
  • Official Title: Phase I Trial of Carbonic Anhydrase Inhibition Associated With Chemotherapy With Cisplatin and Etoposide in Concomitance With Radiotherapy in Localized Small Cell Lung Carcinomas

Clinical Trial IDs

  • ORG STUDY ID: 2017/14
  • NCT ID: NCT03467360

Conditions

  • Small Cell Lung Cancer

Interventions

DrugSynonymsArms
acetazolamide in combination with platinum and etoposide-based radiochemotherapyOne experimental arm

Purpose

The investigators propose to study the carbonic anhydrase inhibition (acetazolamide) associated with concomitant radiochemotherapy in localized small cell lung cancer due to: 1. The over-expression of carbonic anhydrases in this type of cancer, 2. The Anti-tumor effect in preclinical acetazolamide in various tumor lines including neuroendocrine tumor lines, 3. The observed synergy between irradiation and inhibition of carbonic anhydrases, 4. Potential anti-tumor immune effect caused by decreased extracellular acidity.

Detailed Description

      Compared with healthy cells, glucose metabolism is greatly modified in cancer cells because
      of their highly proliferative character. This differential tumor / healthy tissue property is
      an opportunity to be able to propose a treatment whose therapeutic gain can be major
      (targeted treatment). Preclinical studies are multiple and showed that the targeting of
      overexpressed proteins (carbonic anhydrases) and involved in glycolytic metabolism can lead
      to a significant anti-tumor effect. This has never been tested in humans.

      Acetazolamide is a molecule commonly used for non carcinologic purposes but has demonstrated
      anti-tumor activity in preclinical studies; there is also synergy radiotherapy / targeting of
      carbonic anhydrases. Therefore, the investigators propose to study the combination of
      acetazolamide / radiotherapy / chemotherapy with platinum and etoposide in localized Small
      Cell Lung cancer.

      This would be the first study:

        -  targeting glucose metabolism,

        -  testing the effectiveness of acetazolamide in oncology,

        -  testing the synergy radiotherapy / targeting glycolytic metabolism,

        -  trying to manipulate the anti-tumor immune system indirectly, by decreasing
           extracellular acidosis.
    

Trial Arms

NameTypeDescriptionInterventions
One experimental armExperimentalnon randomized, open-label extension cohort, evaluating the safety of acetazolamide in combination with platinum and etoposide-based radiochemotherapy in patients with Localized small lung cancer
  • acetazolamide in combination with platinum and etoposide-based radiochemotherapy

Eligibility Criteria

        Inclusion Criteria:

          -  Age > or = 18 years,

          -  Performance Status 0 to 2,

          -  Patient with an histologically non-metastatic localized Small cell lung cancer,

          -  Patient who must start radiotherapy treatment combined with chemotherapy with platinum
             and etoposide, Note: The decision of the Multidisciplinary Consultation Team must be
             notified in the patient's medical file,

          -  Evaluation lesion according to the criteria RECIST 1.1 and / or according to the
             criteria PERCIST 1.0,

          -  Women of childbearing potential must have a negative serum pregnancy test within 72
             hours of the first administration of the study treatment,

          -  If the patient is a woman of childbearing potential, she must be surgically sterile or
             agree to use two adequate methods of contraception throughout the duration of the
             study until 1 month after the last administration of the study treatment. Subjects of
             childbearing potential are those who have not been surgically sterilized or have not
             been free from menses for > 1 year, Note: Abstinence is acceptable if it is the
             patient's usual and preferred form of contraception,

          -  If the male patient has one or more female partners of childbearing age, he / she must
             agree to use an adequate method of contraception, starting at the first administration
             of the study treatment up to 1 month after the last administration of the treatment.
             of the study, Note: Abstinence is acceptable if it is the patient's usual and
             preferred form of contraception,

          -  Patient willing and able to provide written informed consent/assent for the trial,

          -  Patient affiliated with a health insurance system.

        Exclusion Criteria:

          -  Patient with metastatic disease,

          -  History of thoracic irradiation or near / in the thoracic irradiation field,

          -  Patient who refuses to participate in the study or unable to agree,

          -  Contraindication to thoracic radiotherapy treatment: congestive heart failure
             unbalanced (ejection fraction <30%, clinical signs), severe respiratory failure:

               -  COPD grade IV according to the GOLD classification,

               -  Some GOLD III COPD and any patient with a respiratory defect defined as: oxygen
                  dependence and / or FEV1 <40% normal and / or, DLCO <40% predictive value and /
                  or vital capacity <40% predictive value,

          -  Contraindication to acetazolamide: hypersensitivity to acetazolamide, severe hepatic,
             renal or adrenal insufficiency, sulfonamide intolerance, history of renal colic,
             allergy to wheat other than celiac disease,

          -  Patient currently receiving one or more treatments described in section 6.9 of the
             protocol,

          -  History of cancer, with the exception of cancers in complete remission for more than 5
             years, completely resected basal cell carcinoma of the skin or squamous cell carcinoma
             of the skin that has undergone potentially curative therapy or in situ cervical
             cancer,

          -  People particularly vulnerable as defined in Articles L.1121-5 to -8 of the French
             Healthcare Code, including: person deprived of freedom by an administrative or
             judicial decision, adult being the object of a legal protection measure or outside a
             state to express their consent, pregnant or breastfeeding women
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:To identify the Tolerated Maximum Dose (DMT) and Recommended Dose (DR) of acetazolamide in combination with radiotherapy combined with platinum and etoposide chemotherapy
Time Frame:32 months
Safety Issue:
Description:The frequency of limiting dose toxicities determined by the number of Adverse Events as Assessed by CTCAE v4.03 during the 6 weeks of treatment with acetazolamide / chemoradiation based on platinum and etoposide and in the first 6 months of follow-up after the last administration of the treatment

Secondary Outcome Measures

Measure:To determine the overall tolerance of the association acetazolamide and radiochemotherapy
Time Frame:27 months
Safety Issue:
Description:The overall tolerability of the association acetazolamide and radiochemotherapy during the duration of patient participation will be measured by clinical (performance status), laboratory (blood sample), and paraclinical evaluations (ETT, EFR) and defined on the NCI CTCAE V4.03 scale
Measure:To evaluate the effectiveness of the treatment
Time Frame:24 months
Safety Issue:
Description:The tumor response (complete or partial, stabilization, progression) will be performed by Morphological evaluations using a scanner according to RECIST 1.1 criteria
Measure:To evaluate the effectiveness of the treatment
Time Frame:24 months
Safety Issue:
Description:The tumor response (complete or partial, stabilization, progression) will be performed by Metabolic evaluations using a PET-CT scan according to the criteria PERCIST 1.0
Measure:To identify predictive factors for response to acetazolamide
Time Frame:30 months
Safety Issue:
Description:The evaluation of predictive factors of acetazolamide response will be determined by: o Initial serum CAIX and CAXII levels, in the 7 days before the start of chemoradiotherapy associated with acetazolamide and the end-of-treatment visit
Measure:To identify predictive factors for response to acetazolamide
Time Frame:30 months
Safety Issue:
Description:The evaluation of predictive factors of acetazolamide response will be determined by: o The initial 18-FDG PET-CT scan (SUVmax, SULpeak) fixation intensity and 3 months after treatment,
Measure:To evaluate progression-free survival at 24 months
Time Frame:24 months
Safety Issue:
Description:To determine the delay between the date of inclusion and the date of progression or death
Measure:To evaluate overall survival at 24 months
Time Frame:24 months
Safety Issue:
Description:To determine the delay between the date of inclusion and the date of death
Measure:To determine the compliance of acetazolamide
Time Frame:27 months
Safety Issue:
Description:Compliance assessment will be done using Girerd's questionnaire
Measure:To evaluate the quality of life
Time Frame:27 months
Safety Issue:
Description:Quality of life will be determined using EORTC QLQC30 questionnaire

Details

Phase:Phase 1
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:Centre Antoine Lacassagne

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