Neoplasms

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Carcinoma, Non-Small-Cell Lung

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Carcinoma

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Bronchial Neoplasms

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Tyrosine

- Cisplatin + Docetaxel day 1 q 21 days for 3 cycles

* Gefitinib day for 8 wks;
* Pemetrexed day 1 q 21 days for 3 cycles;
* Docetaxel day 1 + Vinorelbine days 1,8 q 21 days for 3 cycles;
* Docetaxel days 1,8 + Gemcitabine days 1,8 q 21 days for 3 cycles;
* Cisplatin + Docetaxel day 1 q 21 days for 3 cycles;
* Cisplatin day 1+ Gemcitabine days 1,8 q 21 days for 3 cycles;

Cisplatin Docetaxel Gefitinib Pemetrexed Vinorelbine Gemcitabine

Francesco Grossi, MD

* The investigators hypothesized that NSCL patients receiving therapy based on their baseline tumor markers levels would attain higher response rates than patients in the control arm receiving non customized therapy.
* patients with stage IIIA(N2) NSCLC will be randomized in a 2:1 ratio to customized therapy based on biomarkers status (ERCC1, RRM1, TS and EGFR mutation) vs standard chemotherapy.
* The primary objective of this multicenter trial is to compare pathological complete response of all subjects randomized, by treatment arm.
* Secondary objectives are to compare all randomized subjects by treatment arm for: response rate, disease-free survival, overall survival, one, two and three year survival and safety profile.

The study is expected to demonstrate both the feasibility of this approach and the logistic problems associated with a biomarker-driven therapeutic strategy in NSCLC.

- Subjects will be stratified by histology and biological markers (ERCC1, RRM1, TS, EGFR mutation). Randomization will be centralized at the coordinating centre site. Patients will receive chemotherapy with cisplatin + docetaxel or customized therapy for 3 cycles (60 days with gefitinib) before surgery.

Every 4 months for 3 years and then every 6 months for 2 years following surgery, subjects will be assessed by the investigator for adverse events related to study drug, documentation of post study therapies received, DFS, and survival.

- Periodic evaluations of the trial data will be conducted by an independent data monitoring committee to ensure subject safety and the validity and scientific merit of the study.

Assuming that the study is not stopped at the planned futility analyses or for safety reasons, the final analysis will take place after the targeted number of events (pathological complete response) is reached, which is estimated to take place 24 months post study initiation.

- The pathological complete response (pCR)in the two groups will be computed in the ITT populations and compared by means of the chi-square test without continuity correction. For exploratory purposes, a multivariate logistic regression model will be fitted to the data, with the pCR as the response variable and treatment (standard/ experimental) and histo/molecular subgroup as covariate. The heterogeneity of the relative efficacy of the tailored approach in the various subgroups (=subgroup analysis) will be evaluated by including in the model the appropriate set of treatment-by-subgroup interaction terms, using the standard likelihood ratio test. Time-to-event analyses (DFS and OS) will use standard Kaplan-Meier estimators (with the Log-rank test) and semi-parametric PH regression models. Safety will be summarized based on adverse events, vital signs and laboratory assessments. A group sequential design is used to compare the Overall Survival in the two study arms.

Customized Neoadjuvant Versus Standard Chemotherapy in NSCL Patients With Resectable Stage IIIA (N2)Disease

A Multi-center Phase II Randomized Study of Customized Neoadjuvant Therapy Versus Standard Chemotherapy in Non-small Cell Lung Cancer (NSLC) Patients With Resectable Stage IIIA (N2) Disease (CONTEST-TRIAL)

Azienda Sanitaria Locale di Cagliari

Azienda Ospedaliera San Gerardo di Monza

Ospedale Santa Croce-Carle Cuneo

Azienda Ospedaliera S. Maria della Misericordia

Istituto Tumori Giovanni Paolo II, BARI

Azienda Ospedaliera dei Colli Monaldi-Cotugno-CTO, Napoli

Azienda Ospedaliera Santa Maria Degli Angeli

Azienda Ospedaliera San Camillo Forlanini

Azienda Ospedaliera San Giovanni Battista

Azienda Ospedaliera Universitaria Integrata Verona

Azienda Sanitaria Locale n.2 Savonese

ASL TO4, Chivasso

Azienda Provinciale per i Servizi Sanitari, Provincia Autonoma di Trento

Istituto Clinico Humanitas

Azienda Ospedaliera "Sant'Andrea"

Azienda Ospedaliera, Ospedale Civile di Legnano

Azienda Ospedaliera Spedali Riuniti di Livorno, Livorno

IRCCS Azienda Ospedaliera Universitaria San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy

Chief, Lung Cancer Unit

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization	Link
Customized Neoadjuvant Versus Standard Chemotherapy in NSCL Patients With Resectable Stage IIIA (N2)Disease	NCT01784549	Non Small Cell ...	Cisplatin Docet...	18 Years -	IRCCS Azienda Ospedaliera Universitaria San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
Customized Neoadjuvant Versus Standard Chemotherapy in NSCL Patients With Resectable Stage IIIA (N2)Disease	NCT01784549	Non Small Cell ...	Cisplatin Docet...	18 Years -	IRCCS Azienda Ospedaliera Universitaria San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy

Spots Global Cancer Trial Database for cisplatin docetaxel gefitinib pemetrexed vinorelbine gemcitabine