Phase III randomized, double-blind study of maintenance CAI or placebo in patients with advanced non-small cell lung cancer (NSCLC) after completion of initial therapy (NCCTG 97-24-51)

Elizabeth A. Johnson, Randolph Stuart Marks, Sumithra J Mandrekar, Shauna L. Hillman, Mark D. Hauge, Mitchel D. Bauman, Edward J. Wos, Dennis F. Moore, John W. Kugler, Harold E. Windschitl, David L. Graham, Albert M. Bernath, Tom R. Fitch, Gamini S. Soori, James R. Jett, Alex Adjei, Edith A. Perez

Research output: Contribution to journalArticle

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Abstract

Purpose: This study assessed whether maintenance therapy with carboxyaminoimidazole (CAI), compared to placebo, prolonged overall survival in stage IIIB/IV NSCLC patients who had tumour regression or stable disease after treatment with one chemotherapy regimen. Methods: After completion of chemotherapy, patients were randomized to receive daily oral CAI at 250 mg or placebo. Treatment continued until patient refusal, disease progression or unacceptable adverse event (AE). Quality of life (QOL) was assessed by UNISCALE and Functional Assessment of Cancer Therapy for Lung Cancer (FACT-L). Results: Registration was halted early for slow accrual (targeted 360, randomized 186: 94 CAI, 92 placebo). All patients were off active treatment at time of analyses. Non-haematologic AEs (primarily grade 1, 2) observed significantly more often in the CAI group included fatigue (54.5% versus 29.3%), anorexia (31.1% versus 13.0%), nausea (62.2% versus 30.4%), vomiting (32.2% versus 14.1%), neurosensory (60.0% versus 44.6%) and ataxia (33.3% versus 16.3%). Patients discontinued treatment for AEs, death on study or refusal more often in the CAI group (36.0% versus 8.7%, p < 0.0001). No significant differences in survival or time to progression were observed (median: CAI versus placebo: 11.4 months versus 10.5 months, log rank p = 0.54; 2.8 months versus 2.4 months, log rank p = 0.50). More patients receiving CAI reported a clinically significant (10-point) decline in QOL particularly on the functional (58% versus 37%, p = 0.05) construct of FACT-L and UNISCALE (72% versus 51%, p = 0.04). Conclusion: The addition of CAI following chemotherapy does not provide clinical benefit or improvement in QOL over placebo in advanced NSCLC.

Original languageEnglish (US)
Pages (from-to)200-207
Number of pages8
JournalLung Cancer
Volume60
Issue number2
DOIs
StatePublished - May 2008

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Double-Blind Method
Non-Small Cell Lung Carcinoma
Placebos
Maintenance
Lung Neoplasms
Quality of Life
Drug Therapy
Therapeutics
Survival
Anorexia
Ataxia
Nausea
Vomiting
Fatigue
Disease Progression
Neoplasms

Keywords

  • CAI
  • Imidazole
  • Maintenance
  • Non-small cell lung cancer (NSCLC)

ASJC Scopus subject areas

  • Oncology

Cite this

Phase III randomized, double-blind study of maintenance CAI or placebo in patients with advanced non-small cell lung cancer (NSCLC) after completion of initial therapy (NCCTG 97-24-51). / Johnson, Elizabeth A.; Marks, Randolph Stuart; Mandrekar, Sumithra J; Hillman, Shauna L.; Hauge, Mark D.; Bauman, Mitchel D.; Wos, Edward J.; Moore, Dennis F.; Kugler, John W.; Windschitl, Harold E.; Graham, David L.; Bernath, Albert M.; Fitch, Tom R.; Soori, Gamini S.; Jett, James R.; Adjei, Alex; Perez, Edith A.

In: Lung Cancer, Vol. 60, No. 2, 05.2008, p. 200-207.

Research output: Contribution to journalArticle

Johnson, EA, Marks, RS, Mandrekar, SJ, Hillman, SL, Hauge, MD, Bauman, MD, Wos, EJ, Moore, DF, Kugler, JW, Windschitl, HE, Graham, DL, Bernath, AM, Fitch, TR, Soori, GS, Jett, JR, Adjei, A & Perez, EA 2008, 'Phase III randomized, double-blind study of maintenance CAI or placebo in patients with advanced non-small cell lung cancer (NSCLC) after completion of initial therapy (NCCTG 97-24-51)', Lung Cancer, vol. 60, no. 2, pp. 200-207. https://doi.org/10.1016/j.lungcan.2007.10.003
Johnson, Elizabeth A. ; Marks, Randolph Stuart ; Mandrekar, Sumithra J ; Hillman, Shauna L. ; Hauge, Mark D. ; Bauman, Mitchel D. ; Wos, Edward J. ; Moore, Dennis F. ; Kugler, John W. ; Windschitl, Harold E. ; Graham, David L. ; Bernath, Albert M. ; Fitch, Tom R. ; Soori, Gamini S. ; Jett, James R. ; Adjei, Alex ; Perez, Edith A. / Phase III randomized, double-blind study of maintenance CAI or placebo in patients with advanced non-small cell lung cancer (NSCLC) after completion of initial therapy (NCCTG 97-24-51). In: Lung Cancer. 2008 ; Vol. 60, No. 2. pp. 200-207.
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abstract = "Purpose: This study assessed whether maintenance therapy with carboxyaminoimidazole (CAI), compared to placebo, prolonged overall survival in stage IIIB/IV NSCLC patients who had tumour regression or stable disease after treatment with one chemotherapy regimen. Methods: After completion of chemotherapy, patients were randomized to receive daily oral CAI at 250 mg or placebo. Treatment continued until patient refusal, disease progression or unacceptable adverse event (AE). Quality of life (QOL) was assessed by UNISCALE and Functional Assessment of Cancer Therapy for Lung Cancer (FACT-L). Results: Registration was halted early for slow accrual (targeted 360, randomized 186: 94 CAI, 92 placebo). All patients were off active treatment at time of analyses. Non-haematologic AEs (primarily grade 1, 2) observed significantly more often in the CAI group included fatigue (54.5{\%} versus 29.3{\%}), anorexia (31.1{\%} versus 13.0{\%}), nausea (62.2{\%} versus 30.4{\%}), vomiting (32.2{\%} versus 14.1{\%}), neurosensory (60.0{\%} versus 44.6{\%}) and ataxia (33.3{\%} versus 16.3{\%}). Patients discontinued treatment for AEs, death on study or refusal more often in the CAI group (36.0{\%} versus 8.7{\%}, p < 0.0001). No significant differences in survival or time to progression were observed (median: CAI versus placebo: 11.4 months versus 10.5 months, log rank p = 0.54; 2.8 months versus 2.4 months, log rank p = 0.50). More patients receiving CAI reported a clinically significant (10-point) decline in QOL particularly on the functional (58{\%} versus 37{\%}, p = 0.05) construct of FACT-L and UNISCALE (72{\%} versus 51{\%}, p = 0.04). Conclusion: The addition of CAI following chemotherapy does not provide clinical benefit or improvement in QOL over placebo in advanced NSCLC.",
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T1 - Phase III randomized, double-blind study of maintenance CAI or placebo in patients with advanced non-small cell lung cancer (NSCLC) after completion of initial therapy (NCCTG 97-24-51)

AU - Johnson, Elizabeth A.

AU - Marks, Randolph Stuart

AU - Mandrekar, Sumithra J

AU - Hillman, Shauna L.

AU - Hauge, Mark D.

AU - Bauman, Mitchel D.

AU - Wos, Edward J.

AU - Moore, Dennis F.

AU - Kugler, John W.

AU - Windschitl, Harold E.

AU - Graham, David L.

AU - Bernath, Albert M.

AU - Fitch, Tom R.

AU - Soori, Gamini S.

AU - Jett, James R.

AU - Adjei, Alex

AU - Perez, Edith A.

PY - 2008/5

Y1 - 2008/5

N2 - Purpose: This study assessed whether maintenance therapy with carboxyaminoimidazole (CAI), compared to placebo, prolonged overall survival in stage IIIB/IV NSCLC patients who had tumour regression or stable disease after treatment with one chemotherapy regimen. Methods: After completion of chemotherapy, patients were randomized to receive daily oral CAI at 250 mg or placebo. Treatment continued until patient refusal, disease progression or unacceptable adverse event (AE). Quality of life (QOL) was assessed by UNISCALE and Functional Assessment of Cancer Therapy for Lung Cancer (FACT-L). Results: Registration was halted early for slow accrual (targeted 360, randomized 186: 94 CAI, 92 placebo). All patients were off active treatment at time of analyses. Non-haematologic AEs (primarily grade 1, 2) observed significantly more often in the CAI group included fatigue (54.5% versus 29.3%), anorexia (31.1% versus 13.0%), nausea (62.2% versus 30.4%), vomiting (32.2% versus 14.1%), neurosensory (60.0% versus 44.6%) and ataxia (33.3% versus 16.3%). Patients discontinued treatment for AEs, death on study or refusal more often in the CAI group (36.0% versus 8.7%, p < 0.0001). No significant differences in survival or time to progression were observed (median: CAI versus placebo: 11.4 months versus 10.5 months, log rank p = 0.54; 2.8 months versus 2.4 months, log rank p = 0.50). More patients receiving CAI reported a clinically significant (10-point) decline in QOL particularly on the functional (58% versus 37%, p = 0.05) construct of FACT-L and UNISCALE (72% versus 51%, p = 0.04). Conclusion: The addition of CAI following chemotherapy does not provide clinical benefit or improvement in QOL over placebo in advanced NSCLC.

AB - Purpose: This study assessed whether maintenance therapy with carboxyaminoimidazole (CAI), compared to placebo, prolonged overall survival in stage IIIB/IV NSCLC patients who had tumour regression or stable disease after treatment with one chemotherapy regimen. Methods: After completion of chemotherapy, patients were randomized to receive daily oral CAI at 250 mg or placebo. Treatment continued until patient refusal, disease progression or unacceptable adverse event (AE). Quality of life (QOL) was assessed by UNISCALE and Functional Assessment of Cancer Therapy for Lung Cancer (FACT-L). Results: Registration was halted early for slow accrual (targeted 360, randomized 186: 94 CAI, 92 placebo). All patients were off active treatment at time of analyses. Non-haematologic AEs (primarily grade 1, 2) observed significantly more often in the CAI group included fatigue (54.5% versus 29.3%), anorexia (31.1% versus 13.0%), nausea (62.2% versus 30.4%), vomiting (32.2% versus 14.1%), neurosensory (60.0% versus 44.6%) and ataxia (33.3% versus 16.3%). Patients discontinued treatment for AEs, death on study or refusal more often in the CAI group (36.0% versus 8.7%, p < 0.0001). No significant differences in survival or time to progression were observed (median: CAI versus placebo: 11.4 months versus 10.5 months, log rank p = 0.54; 2.8 months versus 2.4 months, log rank p = 0.50). More patients receiving CAI reported a clinically significant (10-point) decline in QOL particularly on the functional (58% versus 37%, p = 0.05) construct of FACT-L and UNISCALE (72% versus 51%, p = 0.04). Conclusion: The addition of CAI following chemotherapy does not provide clinical benefit or improvement in QOL over placebo in advanced NSCLC.

KW - CAI

KW - Imidazole

KW - Maintenance

KW - Non-small cell lung cancer (NSCLC)

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