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Small Cell Lung CancerTransCPCNCT03419286

Transformation Into Small Cell Lung Cancer : a Mode of Resistance to Treatment

An observational study of Small Cell Lung Cancer, run by University Hospital, Grenoble.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The discovery of oncogenic mutations and the use of targeted therapies have transformed the management of certain tumors. Thus 12 to 15% of bronchial adenocarcinomas (AD) carry mutations of EGFR and receive from the first line inhibitors of this kinase (ITK). Read more about this study

Who is it for?
Any age
Conditions the study is for
Small Cell Lung Cancer
How many people
62 participants
Where
No sites listed yet
Study dates
Feb 2016to Nov 2017
Phase
Observational
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages Any age
  • All sexes
  • No healthy volunteers
  • Child, Adult, Older adult

Study population: All cases diagnosed between 2005 to 2017 in France and in Italy who respond at the eligibility criteria were included. they are patients with non small cell lung cancer with or without EGFR mutation at the initial diagnosis transformed into small cell lung cancer during treatment of non small cell lung cancer

Who may be able to join

  • Patient with no history of small cell cancer or Neuroendocrine cancer
  • Patients with non-small cell lung cancer at baseline, stage IIIB or IV
  • Transformation during treatment of non small cell lung cancer, in small cell cancer proven by biopsy

Who cannot join

  • History of small cell cancer or Neuroendocrine cancer
  • Absence of histological evidence of the transformation into small cell lung cancer after treatment of non small cell lung cancer
  • Patients with non-small cell lung cancer at initial biopsy, stage I, II, IIIA

About this study

Official title: Retrospective Study of Cases of Small Cell Lung Cancer (SCLC) That Appeared During Treatment of Another Lung Carcinoma With or Without Oncogenic Activation (TransCPC)

The discovery of oncogenic mutations and the use of targeted therapies have transformed the management of certain tumors. Thus 12 to 15% of bronchial adenocarcinomas (AD) carry mutations of EGFR and receive from the first line inhibitors of this kinase (ITK). Despite spectacular results, relapse and resistance are quasi-general phenomena. In most known cases, EGFR-TKI resistance mechanisms involve secondary mutations of EGFR or the activation of alternative oncogenic pathways. However, in 5 to 15% of patients, resistance is manifested by the emergence of a small cell carcinoma (CPC), a cancer of neuroendocrine origin very different from AD by its cellular, molecular and epidemiological characteristics. This phenotypic transformation is an almost unique phenomenon in oncology and its molecular bases are not understood. To study this phenomenon, a Franco-Italian network was established that documented and collected cases of this rare tumor. This series is the subject of detailed anatomopathological, clinical and therapeutic documentation. This project aims to investigate the exome of one or more matched lesion regions to evaluate the evolutionary processes leading from the initial AD to the relapsing CPC. These results will guide future research on predictive markers of relapse and their targeted treatment.

Read the detailed description

An international multicentric retrospective collection of cases was performed between 2005 and 2017. A global e-mailing to a network of thoracic oncology centers in France and Italy called for the selection of retrospective cases. Consecutive non small cell lung cancer (NSCLC) patients with stage III or IV EGFR NSCLC with or without initial EGFR mutation with a secondary transformation to small cell lung cancer (SCLC) in participating centers in France and Italy were included. Patients with a previous history of SCLC or neuroendocrine tumor of the lung were excluded as well as patients with combined Small cell/ Non-small cell lung cancer on the initial pathology sample.

Study ethics approval was obtained on December 8th of 2015 (CECIC Rhône-Alpes-Auvergne, Clermont-Ferrand, IRB 5891). Anonymized data were collected at each center then centrally analyzed at the Albert Bonniot Institute, Inserm U 823, Grenoble Alpes University, in Grenoble, France.

The primary objective of this study was to analyze survival data after transformation to SCLC. The secondary objectives were to define: the epidemiological characteristics at the time of diagnosis of NSCLC, the histomolecular characteristics at the time of diagnosis of NSCLC and at the time of diagnosis of SCLC; the clinical characteristics at the time of diagnosis of NSCLC and SCLC and the treatment characteristics before and after transformation from NSCLC to SCLC.

All identified cases will be analyzed. This concerns about sixty two patients because the transformation into small cell lung cancer is a rare mechanism of resistance, it is for this reason that all the cases will be included in order to obtain the most exhaustive data possible.

Continuous variables were described as median (25%-75% interquartile range [IQR]) and categorical variables as number (%). Associations between categorical variables were compared using the chi-2 test or Fisher's exact test and those between continuous variables using the Wilcoxon test. Patients were followed until November of 2017. Overall survival (OS) is the time from the initial diagnosis of lung cancer to death and survival after SCLC transformation is from the rebiopsy to death. Kaplan-Meier plots of survival curves were compared between groups using the log-rank test. All tests were two-sided, and P values <0.05 were considered statistically significant. All statistical analyses were performed using SAS 9.3 (SAS Institute, Cary, NC, USA).

Medical subject headings
Small Cell Lung Carcinoma

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

Study groups in NCT03419286
Study groupRoleWhat they receive
EGFR MUTATEDpatient with lung cancer with EGFR mutation before transformation into small cell lung cancer
EGFR NON MUTATEDpatient with lung cancer without driver oncogenic before transformation into small cell lung cancer

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. survival time after transformation to small cell lung cancer (SCLC)

    months of survival after transformation into small cell lung cancer

    Measured: 2005 to 2017

Secondary outcomes (11)
  1. time from initial diagnosis of non small cell lung cancer (NSCLC) to small cell lung cancer transformation

    median of months between initial diagnosis of non small cell lung cancer and small cell lung cancer transformation

    Measured: 2005 to 2017

  2. histology type at the time of diagnosis of NSCLC and at the time of diagnosis of small cell lung cancer (SCLC)

    histology on biopsy at the initial diagnosis and at transformation according with OMS classification

    Measured: 2005 to 2017

  3. type of specific treatments administered before and after transformation from non small cell lung cancer into small cell lung cancer

    The type of treatment administered before and after SCLC transformation. percentage of patients in each type of specific treatment used

    Measured: 2005 to 2017

  4. sexe of patients

    sexe female or male in percentage of patients

    Measured: 2005 to 2017

  5. stage of NSCLC at initial diagnosis

    percentage of patients with stage III and with IV of NSCLC

    Measured: 2005 to 2017

  6. smocking status at diagnosis initial of non small cell lung cancer

    percentage of patients in never, former or active smokers

    Measured: 2005 to 2017

  7. type of mutations at the diagnostic initial NSCLC and at transformation

    the mutation on initial biopsy and on biopsy at transformation in SCLC in percentage of patients

    Measured: 2005 to 2017

  8. treatment lines before transformation into small cell lung cancer (SCLC)

    Median number of lines of treatment for the NSCLC before transformation into SCLC

    Measured: 2005 to 2017

  9. response rates to first line treatment after transformation into small cell lung cancer

    response rate in percentage of patients after transformation into SCLC according with the RECIST criteria

    Measured: 2005 to 2017

  10. lines of treatment after transformation into SCLC

    median number of lines of treatment after transformation into SCLC

    Measured: 2005 to 2017

  11. age of patients

    the median in years at the he diagnosis initial of non small cell lung cancer

    Measured: 2005 to 2017

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted1 Feb 2018
  2. Study startFeb 2016
  3. Primary completionNov 2017
  4. Study completionNov 2017

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Case only
Time perspective
Retrospective
Enrolment
62 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03419286
Sponsor's protocol ID
38RC16.053
Acronym
TransCPC
Status last verified
Jan 2018
First submitted
18 Jan 2018
Last updated
1 Feb 2018
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided

Publications

  • Sequist LV, Waltman BA, Dias-Santagata D, Digumarthy S, Turke AB, Fidias P, Bergethon K, Shaw AT, Gettinger S, Cosper AK, Akhavanfard S, Heist RS, Temel J, Christensen JG, Wain JC, Lynch TJ, Vernovsky K, Mark EJ, Lanuti M, Iafrate AJ, Mino-Kenudson M, Engelman JA. Genotypic and histological evolution of lung cancers acquiring resistance to EGFR inhibitors. Sci Transl Med. 2011 Mar 23;3(75):75ra26. doi: 10.1126/scitranslmed.3002003.

    PubMed 21430269
  • Yu HA, Arcila ME, Rekhtman N, Sima CS, Zakowski MF, Pao W, Kris MG, Miller VA, Ladanyi M, Riely GJ. Analysis of tumor specimens at the time of acquired resistance to EGFR-TKI therapy in 155 patients with EGFR-mutant lung cancers. Clin Cancer Res. 2013 Apr 15;19(8):2240-7. doi: 10.1158/1078-0432.CCR-12-2246. Epub 2013 Mar 7.

    PubMed 23470965
  • Niederst MJ, Sequist LV, Poirier JT, Mermel CH, Lockerman EL, Garcia AR, Katayama R, Costa C, Ross KN, Moran T, Howe E, Fulton LE, Mulvey HE, Bernardo LA, Mohamoud F, Miyoshi N, VanderLaan PA, Costa DB, Janne PA, Borger DR, Ramaswamy S, Shioda T, Iafrate AJ, Getz G, Rudin CM, Mino-Kenudson M, Engelman JA. RB loss in resistant EGFR mutant lung adenocarcinomas that transform to small-cell lung cancer. Nat Commun. 2015 Mar 11;6:6377. doi: 10.1038/ncomms7377.

    PubMed 25758528
  • Oser MG, Niederst MJ, Sequist LV, Engelman JA. Transformation from non-small-cell lung cancer to small-cell lung cancer: molecular drivers and cells of origin. Lancet Oncol. 2015 Apr;16(4):e165-72. doi: 10.1016/S1470-2045(14)71180-5.

    PubMed 25846096
  • Crystal AS, Shaw AT, Sequist LV, Friboulet L, Niederst MJ, Lockerman EL, Frias RL, Gainor JF, Amzallag A, Greninger P, Lee D, Kalsy A, Gomez-Caraballo M, Elamine L, Howe E, Hur W, Lifshits E, Robinson HE, Katayama R, Faber AC, Awad MM, Ramaswamy S, Mino-Kenudson M, Iafrate AJ, Benes CH, Engelman JA. Patient-derived models of acquired resistance can identify effective drug combinations for cancer. Science. 2014 Dec 19;346(6216):1480-6. doi: 10.1126/science.1254721. Epub 2014 Nov 13.

    PubMed 25394791
  • Ross JS, Wang K, Elkadi OR, Tarasen A, Foulke L, Sheehan CE, Otto GA, Palmer G, Yelensky R, Lipson D, Chmielecki J, Ali SM, Elvin J, Morosini D, Miller VA, Stephens PJ. Next-generation sequencing reveals frequent consistent genomic alterations in small cell undifferentiated lung cancer. J Clin Pathol. 2014 Sep;67(9):772-6. doi: 10.1136/jclinpath-2014-202447.

    PubMed 24978188
  • Suda K, Murakami I, Sakai K, Mizuuchi H, Shimizu S, Sato K, Tomizawa K, Tomida S, Yatabe Y, Nishio K, Mitsudomi T. Small cell lung cancer transformation and T790M mutation: complimentary roles in acquired resistance to kinase inhibitors in lung cancer. Sci Rep. 2015 Sep 24;5:14447. doi: 10.1038/srep14447.

    PubMed 26400668
  • Du L, Schageman JJ, Irnov, Girard L, Hammond SM, Minna JD, Gazdar AF, Pertsemlidis A. MicroRNA expression distinguishes SCLC from NSCLC lung tumor cells and suggests a possible pathological relationship between SCLCs and NSCLCs. J Exp Clin Cancer Res. 2010 Jun 17;29(1):75. doi: 10.1186/1756-9966-29-75.

    PubMed 20624269
  • Shoemaker AR, Mitten MJ, Adickes J, Ackler S, Refici M, Ferguson D, Oleksijew A, O'Connor JM, Wang B, Frost DJ, Bauch J, Marsh K, Tahir SK, Yang X, Tse C, Fesik SW, Rosenberg SH, Elmore SW. Activity of the Bcl-2 family inhibitor ABT-263 in a panel of small cell lung cancer xenograft models. Clin Cancer Res. 2008 Jun 1;14(11):3268-77. doi: 10.1158/1078-0432.CCR-07-4622.

    PubMed 18519752
  • Lee JK, Lee J, Kim S, Kim S, Youk J, Park S, An Y, Keam B, Kim DW, Heo DS, Kim YT, Kim JS, Kim SH, Lee JS, Lee SH, Park K, Ku JL, Jeon YK, Chung DH, Park PJ, Kim J, Kim TM, Ju YS. Clonal History and Genetic Predictors of Transformation Into Small-Cell Carcinomas From Lung Adenocarcinomas. J Clin Oncol. 2017 Sep 10;35(26):3065-3074. doi: 10.1200/JCO.2016.71.9096. Epub 2017 May 12.

    PubMed 28498782

Questions about this trial

What is this clinical trial studying?

An observational study of Small Cell Lung Cancer, run by University Hospital, Grenoble.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 1 Feb 2018. Status can change between updates, so confirm with the study contact before making plans.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

survival time after transformation to small cell lung cancer (SCLC) (time frame: 2005 to 2017). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03419286, which also lists 10 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 1 Feb 2018.

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