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A Randomised trial of predictive assay-directed chemotherapy in non-small cell lung cancer (NSCLC) and mesothelioma

ACTRN 12611000728932

Brief Summary

Lung cancer is the most common cause of cancer-related deaths. Although some improvements in the treatment of early stage lung cancer have occurred, the majority of participants still present with advanced (non-operable) disease. The treatments for participants with advanced lung cancer are mostly palliative using various treatments, including chemotherapy, targeted therapies and radiotherapy. This study looks at whether response rates to an assay-directed chemotherapy regime – adenosine triphosphate tumour cell assay (ATP-TCA) – may be greater than in patients who are receiving current, standard chemotherapy for lung cancer.

Intervention/Treatment

  • Drug: Carboplatin
  • Drug: Docetaxel
  • Drug: Pemetrexed
  • Drug: Vineralbine
  • Drug: Gemcitabine
  • Drug: Irinotecan
  • Drug: Abraxane

Inclusion Criteria

  1. Participants with a confirmed diagnosis of inoperable non small cell lung cancer or mesothelioma aged >18 years.
  2. ECOG performance status of 0, 1 or 2.
  3. Stage IIIB or stage IV NSCLC or mesothelioma.
  4. Life expectancy of at least 3 months.
  5. One lesion amenable to thoroscopic biopsy.
  6. Presence of one measurable lesion as per RESIT criteria.
  7. No previous radiotherapy.
  8. Adequate bone marrow function:
    • Neutrophil count > 1.5 x 109/L.
    • Platelets = 100 x 109/L.
    • Haemoglobin > 100g/L.
  9. Adequate hepatic function:
    • Bilirubin < upper limit for institution (except Gilberts disease).
    • ALT/AST = <1.5 x ULN for institution. In situations where the participant has liver metastasises an elevated <5 x ULN is acceptable.
    • Alkaline phosphatase = <2.5 x ULN for institution.
  10. Adequate renal function:
    • Creatine within normal institutional limits OR
    • Creatine clearance >60 ml/min for participant with creatine levels above institutional normal range. (either measured or calculated using Cockroft-Gault formula).
  11. At least 2 million viable cancer cells recoverable from a biopsy or pleural aspiration.
  12. Participants must be able commence treatment within 7 days of ATP-TCA test result.
  13. Women of child-bearing potential must have a negative pregnancy test and agree to use an accepted and effective method of non-hormonal barrier contraception (barrier method of birth control, abstinence.
  14. An ability to understand and the willingness to sign a written informed consent document.
  15. Participants must be accessible for follow up.
  16. Participants must be informed of and agree to data and tissue material transfer and handling, in accordance with national data protection guidelines.

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