Docetaxel With or Without PI-88 in Treating Patients With Stage IIIB or Stage IV Non-Small Cell Lung Cancer

OBJECTIVES:

Primary

• Compare the safety and efficacy of docetaxel with vs without PI-88 in patients with stage IIIB or IV non-small cell lung cancer.

Secondary

• Determine the efficacy markers of docetaxel and PI-88 in these patients.
• Determine the safety and potential efficacy of PI-88 alone as maintenance therapy in patients whose disease has been controlled with docetaxel and PI-88 combination therapy.
• Determine the safety and potential efficacy of PI-88 alone as third-line therapy in these patients.

OUTLINE: This is an open-label, randomized, multicenter study. Patients are randomized to 1 of 2 treatment arms.

• Arm I: Patients receive docetaxel IV over 1 hour on days 1, 8, and 15.
• Arm II: Patients receive docetaxel as in arm I. Patients also receive PI-88 subcutaneously once daily on days 1-4, 8-11, and 15-18.

In both arms, treatment repeats every 28 days for up to 6 courses in the absence of disease progression or unacceptable toxicity. Patients in arm II with stable or responding disease after 6 courses may continue to receive PI-88 alone as maintenance therapy. Patients in arm I with progressive disease or unacceptable toxicity before the completion of 6 courses may receive PI-88 alone as third-line therapy.

PROJECTED ACCRUAL: Approximately 100 patients will be accrued for this study.

DISEASE CHARACTERISTICS:

• Diagnosis of non-small cell lung cancer

• Stage IIIB or IV disease
• Eligible for second-line docetaxel

• Disease progression during or after completion of prior first-line therapy comprising radiotherapy and/or platinum-based chemotherapy

PATIENT CHARACTERISTICS:

Age

• 18 and over

Performance status

• ECOG 0-1

Life expectancy

• At least 2 months

Hematopoietic

• Neutrophil count > 1,500/mm^3
• Platelet count > 100,000/mm^3
• WBC > 3,000/mm^3
• No history of thrombotic thrombocytopenic purpura or other platelet disease

Hepatic

• Bilirubin normal
• ALT and AST ≤ 2.5 times upper limit of normal (ULN) (1.5 times ULN if alkaline phosphatase > 2.5 times ULN)
• Alkaline phosphatase ≤ 5 times ULN (unless bone metastases are present)
• PT < 1.5 times ULN
• Activated PTT normal

Renal

• Creatinine clearance or glomerular filtration rate > 50mL/min

Cardiovascular

• None of the following within the past 3 months:

• Myocardial infarction
• Stroke
• Congestive heart failure

Immunologic

• No history of immune-mediated thrombocytopenia
• No evidence of anti-heparin antibodies
• No history of allergy and/or hypersensitivity to anti-coagulants or thrombolytic agents, especially heparin
• No history of allergy to polysorbate 80
• No uncontrolled or serious infection within the past 4 weeks

Other

• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception

PRIOR CONCURRENT THERAPY:

Biologic therapy

• Not specified

Chemotherapy

• See Disease Characteristics
• No prior docetaxel

Endocrine therapy

• Not specified

Radiotherapy

• See Disease Characteristics
• More than 3 months since prior radiotherapy to > 30% of marrow-bearing bone
• Concurrent local palliative radiotherapy allowed

Surgery

• More than 4 weeks since prior major surgery

Other

• More than 4 weeks since prior antineoplastic therapy
• More than 2 weeks since prior and no concurrent heparin or low-molecular weight heparin
• More than 4 weeks since prior investigational therapy
• No concurrent aspirin or aspirin-containing medications except low-dose aspirin (≤ 100 mg/day)
• No concurrent nonsteroidal anti-inflammatory drugs except cyclooxygenase-2 inhibitors
• No concurrent warfarin or warfarin-containing medications except low-dose warfarin (≤ 1 mg/day)
• No concurrent antiplatelet drugs, including any of the following:

• Abciximab
• Clopidogrel
• Dipyridamole
• Ticlopidine
• Tirofiban
• No concurrent drugs that may inhibit docetaxel metabolism, including any of the following:

• Cyclosporine
• Terfenadine
• Ketoconazole
• Erythromycin
• Troleandomycin
• No other concurrent investigational drugs
• No other concurrent antineoplastic therapy