Paclitaxel, Carboplatin, and Dimethylxanthenone Acetic Acid in Treating Patients With Extensive-Stage Small Cell Lung Cancer

OBJECTIVES:

Primary

• To assess the 24-week (6 months) progression-free survival of patients with extensive stage small cell lung cancer treated with paclitaxel, carboplatin, and dimethylxanthenone acetic acid.

Secondary

• To assess efficacy and safety of this regimen in these patients.
• To evaluate predictive molecular markers for gene expression analyses, serum proteomics, and pharmacogenomics. (exploratory)

OUTLINE: This is a multicenter study.

Patients receive paclitaxel IV over 3 hours, carboplatin IV over 30 minutes, and dimethylxanthenone acetic acid IV over 20 minutes on day 1. Treatment repeats every 21 days for up to 6 courses in the absence of disease progression or unacceptable toxicity.

Blood and tissue samples may be collected periodically for predictive molecular markers for gene expression analysis, plasma proteomics, and pharmacogenomics.

After completion of study treatment, patients are followed every 6 months.

DISEASE CHARACTERISTICS:

• Histologically (preferred) or cytologically confirmed small-cell lung carcinoma (SCLC) by surgical biopsy, brushing, washing, OR core needle aspiration (sputum cytology alone not acceptable)

• Extensive stage or stage IV disease, including patients with malignant pleural or pericardial effusion

• No pleural effusion that causes ≥ CTC grade 2 dyspnea
• Not suitable for potentially curative combined-modality treatment for this disease
• Measurable or non-measurable disease
• No CNS metastases

PATIENT CHARACTERISTICS:

• WHO performance status 0-2
• Hemoglobin ≥ 10.0 g/dL
• Absolute neutrophils ≥ 2.0 x 10^9/L (without the use of growth factors)
• Platelet count ≥ 100 x 10^9/L
• Bilirubin ≤ 1.5 x the upper limit of normal (ULN)
• ALT ≤ 2.5 x ULN (≤ 5 x ULN if liver metastases)
• Alkaline phosphatase ≤ 2.5 x ULN (≤ 5 x ULN if liver metastases)
• Creatinine clearance ≥ 45 mL/min
• INR ≤ 1.5
• Magnesium, potassium, and calcium (corrected for albumin) normal
• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception during and for 12 months after completion of study therapy
• No recent hemoptysis associated with SCLC (> 1 teaspoon in a single episode within 4 weeks)
• No other malignancy within the past 5 years except for nonmelanoma skin cancer or cervical cancer in situ
• Must not have a history of any of the following conditions:

• Myocardial infarction within the past 12 months
• Uncontrolled hypertension (systolic BP > 160 mm Hg and/or diastolic BP > 90 mm Hg) or poor compliance with anti-hypertensive regimen
• Sustained ventricular tachycardia
• Ventricular fibrillation or Torsades de Pointes
• Long QT syndrome
• QTc of > 450 msec
• NYHA class III or IV congestive heart failure
• Unstable or poorly controlled angina pectoris, including Prinzmetal variant angina pectoris
• Right bundle branch block and left anterior hemiblock (bifascicular block)
• Bradycardia (defined as heart rate < 50 beats per minute)
• Cardiac arrhythmias (i.e., symptomatic, but may not require medications) CTCAE grade ≥ 2
• No significant neurologic or psychiatric disorder that would compromise study participation
• No peripheral sensory neuropathy with functional impairment ≥ CTC grade 2 (regardless of cause)
• No concurrent severe and/or uncontrolled medical disease, including any of the following:

• Uncontrolled diabetes
• Chronic renal disease
• Chronic liver disease
• Confirmed diagnosis of HIV infection
• Active uncontrolled infection
• No serious underlying medical condition, in the judgment of the investigator, that would impair the patient's ability to participate in the trial
• No known hypersensitivity to study drugs or to any other component of the study drugs (taxanes or other drugs formulated in Cremophor EL [polyoxyethylated castor oil])

PRIOR CONCURRENT THERAPY:

• Recovered from all prior therapy
• No prior systemic chemotherapy, immunotherapy, or biologic anti-cancer therapy
• More than 2 weeks since prior and no concurrent radiotherapy

• Localized palliative radiotherapy to symptomatic bone metastases allowed
• More than 2 weeks since minor surgery

• Insertion of a vascular access device allowed
• More than 3 weeks since prior dimethylxanthenone acetic acid for prophylactic cranial irradiation
• More than 4 weeks since major surgery (defined by the use of general anesthesia)
• At least 30 days since prior and no other concurrent investigational drugs or anti-cancer therapy
• No treatment in a clinical trial within 30 days prior to trial entry
• No concurrent therapy with a risk of causing Torsades de Pointes
• No concurrent drugs that would be contraindicated for use with study drugs
• No factors with the potential to prolong QT interval