Phase I/II Calcitriol in Lung Cancer



Status:Terminated
Conditions:Lung Cancer, Cancer
Therapuetic Areas:Oncology
Healthy:No
Age Range:18 - Any
Updated:12/14/2017
Start Date:December 2008
End Date:August 2013

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A Phase I/II Clinical Trial of Intravenous (IV) Calcitriol With Fixed Dose of Cisplatin and Docetaxel in Advanced Non-Small Cell Lung Cancer

According to the Cancer Atlas, lung cancer remains the major cancer among the 10.9 million
new cases of cancer diagnosed annually worldwide. The mortality from lung cancer is greater
than the combined mortality for breast, colon and prostate cancer combined. Most patients
with metastatic non-small-cell lung cancer (NSCLC) are treated with platinum-based
chemotherapy regimens. The drug combination of cisplatin and docetaxel is one of the commonly
used regimens in metastatic NSCLC. Although both drugs are powerful disruptors of cell
growth, positive therapeutic response rates to this therapy remain low for NSCLC patients,
from 25% to 30%. While adding new biologics such as bevacizumab to the current treatment
standard can improve treatment response, median survival for advanced NSCLC patients
receiving this type of treatment remains low at under 12 months. Research studies have
demonstrated that Vitamin D, and it's signaling pathways are important biological targets in
cancer therapeutics. In vitro and in vivo calcitriol (1, 25 dihydroxycholecalciferol) is
antiproliferative and potentiates the antitumor effects of cytotoxic agents (e.g. taxanes,
platinum analogues). We have shown that administration of high doses of calcitriol and
cisplatin is feasible and associated with complete tumor regressions in dogs with spontaneous
cancers. Calcitriol has also shown to be synergistic with docetaxel both in preclinical as
well as in a recent phase II clinical trial in prostate cancer. Based on these results and
other supporting data from studies indicating that calcitriol functions as a potent and well
tolerated anti-tumor agent when used in combination with drugs likes cisplatin and docetaxel,
we hypothesize that introducing calcitriol into treatment regimes for NSCLC patients has the
potential to demonstrably improve treatment response for these patients. The overall goals
for conducting this phase I/II clinical study will be (1) to determine the maximum tolerated
dose (MTD) and dose limiting toxicities (DLT) of calcitriol in combination with
cisplatin/docetaxel in patients with advanced NSCLC, (2) to assess the response rates of
patients with advanced NSCLC to the combination of calcitriol with cisplatin/docetaxel, (3)
to evaluate the pharmacokinetics (PK) of administering calcitriol intravenously at the MTD,
and (4) to evaluate correlations between calcitriol PK and changes on specific coding regions
of the gene associated with calcitriol breakdown.


Inclusion Criteria:

1. Proven histological or cytological diagnosis of stage IIIB (malignant pleural
effusion) IV NSCLC.

2. Age more than 18 years

3. Performance status must be ECOG 0-1.

4. No prior or concurrent malignancy, except non-melanoma skin cancer, or CIS of the
cervix, unless documented disease-free for more than 2 years.

5. No prior use of chemotherapy for stage IV NSCLC; Adjuvant therapy is permitted.

6. Adequate bone marrow, hepatic, and renal function, as evidenced by the following: WBC
3.0 x 109/L, neutrophils 1.5 x 109 /L; platelet count 100 x 109/L; Hgb> 10 g/dL (may
be transfused to 10g/dL); total bilirubin within the upper limit of the institutional
normal range; (transaminases SGOT or SGPT) 1.5 times the upper limit of the
institutional normal range. Creatinine within the upper limit of the institutional
normal range; creatinine clearance >50 ml/min

7. Patients must have measurable or evaluable disease (not required for the phase I part
of the study)

8. Normal cardiac function with no history of uncontrolled heart disease

9. Female patients must not be pregnant; they must be post-menopausal or practicing an
accepted form of birth control. If pregnancy is a possibility, a pregnancy test will
be required prior to initiation of therapy.

10. Life expectancy of at least 12 weeks.

11. Patient and investigator signed study-specific consent form, indicating the
investigational nature of the study

12. Patients must be accessible for treatment and follow-up.

13. No chemotherapy or radiotherapy within 3 weeks of study entry defined here as day 1 of
therapy with calcitriol plus chemotherapy (6 weeks for mitomycin C or a nitrosourea).

14. No treatment with investigational drugs within 3 weeks of study entry.

15. No other serious illness or medical condition including unstable cardiac disease
requiring treatment, new onset crescendo or rest angina; history of significant
neurological or psychiatric disorders including psychotic disorders, dementia, or
seizures; or active infection are permitted. No evidence of grade > 2 peripheral
neuropathy. No history of severe hypersensitivity reaction to docetaxel or other drugs
formulated with polysorbate 80

16. Palliative radiation is permitted (as long as marrow exposed not greater than 10%;
please see Appendix IV for reference) At least 1 week since the last palliative XRT.

17. Treated brain metastasis allowed with no waiting period following gamma knife and at
least 2 weeks after whole brain XRT as long as neurologically stable.

Exclusion Criteria:

1. Known hypersensitivity to Vitamin D, docetaxel, cisplatin

2. Hypercalcemia (patients with serum albumin corrected calcium* > 10.7 mg/dL)

3. History of renal/bladder stones over the past 10 years

4. History of nephrectomy.

5. Uncontrolled heart disease, unstable angina, heart failure, current digoxin therapy

6. Thiazide, Digoxin or glucocorticoid therapy (except the pre-medication Dexamethasone
used in the study as prescribed)

7. Unwillingness to stop calcium supplementation

8. Concurrent use of Phenytoin, Barbiturates, Rifampin, Carbamazepine, Phenobarbital or
St John's wort.

9. Treatment with any investigational drug within 3 weeks before Day 1 of protocol

10. Any unresolved toxicity (NCI CTCAE version 3.0,>2) (Please see appendix V for link)

11. Pregnancy/Lactation

12. Patients with IIIB NSCLC who are eligible for definitive chemoradiation.

- Ca corrected = Ca (measured) + (0.8 x (4 - albumin))
We found this trial at
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sites
Ann Arbor, Michigan 48197
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666 Elm Street
Buffalo, New York 14263
(716) 845-2300
Roswell Park Cancer Institute Welcome to Roswell Park Cancer Institute (RPCI), America's first cancer center...
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1500 East Medical Center Drive
Ann Arbor, Michigan 48109
800-865-1125
University of Michigan Comprehensive Cancer Center The U-M Comprehensive Cancer Center's mission is the conquest...
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Ann Arbor, Michigan 48113
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