Evaluation of Non-cytotoxic Suramin as a Chemosensitizer in Non-small Cell Lung Cancer

The primary objective is to determine the progression free survival for patients with stage III B with malignant pleural effusion or Stage IV NSCLC treated with docetaxel and carboplatin with or without suramin.

The secondary objectives are to compare median overall survival rate, compare overall response rate of patients in both arms, assess toxicity of suramin with docetaxel and carboplatin, determine whether pre-treatment bFGF levels correlate with survival, to determine whether survival benefit from suramin is associated with M phase entry in peripheral blood lymphocytes, and to determine whether adding suramin to docetaxel and carboplatin produces greater survival benefits in African-American patients.

• Suramin Drug:Docetaxel Drug: Carboplatin (Drug), also known as CI-1003, PD 002927-0015F, NSC 34936, Bayer 205, Germanin, Metaret, Taxotere, Paraplatin: Suramin dosage will be determined by nomogram and administered over 30 minutes. Suramin is followed by docetaxel (56 mg/m2, administered over 1 hour), followed by carboplatin (dosage calculated by Calvert equation to have a target AUC of 6, administered over 1 hour).
• Placebo Drug: Docetaxel Drug: Carboplatin (Drug), also known as Taxotere, Paraplatin: Placebo (100 ml of 0.9% sodium chloride or 5% dextrose in water) will be administered over 30 minutes, followed by docetaxel (75 mg/m2, administered over 1 hour), followed by carboplatin (dose calculated by Calvert equation to have a target AUC of 6, administered over 1 hour).

Primary outcomes

• Progression-free Survival for Participants With Stage IIIB/IV NSCLC Per RECIST Criteria [Patients will be followed every 2 months for the first 6 months following the last cycle of treatment, every three months for the next year, and every 6 months thereafter.]: Insufficient data

Secondary outcomes

• Overall Survival of Participants [First treatment date to date of death]: Insufficient Data
• Overall Response Rate (Complete Response + Partial Response) of Participants [Tumor assessment at every other cycle]: Insufficient data
• Toxicity of Combination of Non-cytotoxic Suramin With Docetaxel and Carboplatin. [Day 1 of each cycle; end of treatment visit; at follow-up.]: Insufficient data.
• Pre-treatment bFGF Levels Correlation With Survival. [Before first treatment]: Insufficient data.
• Survival Benefit From Non-cytotoxic Suramin Association With Reduced M-phase Entry in Peripheral Blood Lymphocytes [Randomization date]: Insufficient data.
• To Determine Whether Adding Non-cytotoxic Suramin to Docetaxel and Carboplatin Produces Survival Benefits in African-American Patients. [Randomization date to date of death]: Insufficient data.
• To Determine Whether Adding Non-cytotoxic Suramin to Docetaxel and Carboplatin Produces Greater Survival Benefits in African-American Patients Compared to Non-African-American Patients. [Randomization date to date of death]: Insufficient data.

Sex: All, ages: 18 Years to any

Inclusion Criteria:

* Histologically or cytologically proven on-small cell lung cancer (NSCLC), including squamous cell carcinoma.
* Newly-diagnosed stage IIIB with malignant pleural effusion, stage IV or recurrent disease.
* Known central nervous system metastases if patients are asymptomatic and have completed whole brain or stereotactic radiation at least 2 weeks prior or surgery at least 4 weeks prior to starting treatment on this protocol. Must be off dexamethasone at the time of starting treatment.
* Must have completed radiotherapy at least two weeks prior to registration. Prior radiation therapy is eligible if patient has a measurable lesion that has not been irradiated.
* Must have measurable disease, defined as at least one lesion that can be accurately measured in at least one dimension (RECIST criteria).
* Lesions that are not considered measurable include the following:

  * Bone lesions
  * Leptomeningeal disease
  * Ascites
  * Pleural/pericardial effusion
  * Abdominal masses that are not confirmed and followed by imaging techniques
  * Cystic lesions
  * Tumor lesions situated in a previously irradiated area
* ECOG performance status of 0-1.
* Life expectancy ≥ 3 months.
* Adequate bone marrow function, absolute neutrophil count ≥1,500/mm3, hemoglobin ≥9.9 gm/dl, and platelet count ≥100,000/mm3.
* Adequate liver function defined as bilirubin ≤ 1x upper level of the institutional normal (ULIN). AST and ALT and Alkaline Phosphatase must be within the range allowing for eligibility. In determining eligibility the more abnormal of the two values (AST or ALT) should be used. See protocol.
* Must have adequate renal function defined as serum creatinine ≤ 2.0 mg/dl or calculated creatinine clearance ≥ 60 ml/min for patients with creatinine levels above 2.0 mg/dl.
* Must have recovered from uncontrolled intercurrent illness, including ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris or cardiac arrhythmia.
* Use of adequate contraception (hormonal or barrier method of birth control) for the duration of study participation and continued for at least three months after completing treatment. Non-pregnant status will be determined in all women of childbearing potential.
* Age > 18.
* Patients must have given written informed consent.
* Entry to this study is open to both men and women and to all racial and ethnic subgroups. The goal is to accrue a minimum of 44 patients of African-American ancestry and a maximum of 120 non-African-American patients. Classification of patient race and ancestry will be based on patient's self-identification on the consent form for the clinical trial.

Exclusion Criteria:

* History of severe hypersensitivity reaction to Docetaxel or other drugs formulated with polysorbate 80.
* Grade 3 or 4 neuropathy.
* Women who are pregnant or breast-feeding.
* Prior chemotherapy or biologic therapy (e.g., erlotinib) for NSCLC including neoadjuvant or adjuvant chemotherapy.
* Currently active second malignancy other than non-melanoma skin cancer. Currently active malignancy does not include prior malignancy treated with therapy and considered to have less than 30% risk of relapse.

Participant flow

Outcome results

• Progression-free Survival for Participants With Stage IIIB/IV NSCLC Per RECIST Criteria (Primary)
• Overall Survival of Participants (Secondary)
• Overall Response Rate (Complete Response + Partial Response) of Participants (Secondary)
• Toxicity of Combination of Non-cytotoxic Suramin With Docetaxel and Carboplatin. (Secondary)
• Pre-treatment bFGF Levels Correlation With Survival. (Secondary)
• Survival Benefit From Non-cytotoxic Suramin Association With Reduced M-phase Entry in Peripheral Blood Lymphocytes (Secondary)
• To Determine Whether Adding Non-cytotoxic Suramin to Docetaxel and Carboplatin Produces Survival Benefits in African-American Patients. (Secondary)
• To Determine Whether Adding Non-cytotoxic Suramin to Docetaxel and Carboplatin Produces Greater Survival Benefits in African-American Patients Compared to Non-African-American Patients. (Secondary)

Adverse events

Serious adverse events by term

Other adverse events by term

Limitations and caveats: The study was terminated prematurely due to the loss of follow-up of 6 of 14 participants before progression and slow accrual. Due to the resulting small numbers, no analysis was attempted.