Continuous Infusion of Cilengitide Plus Chemoradiotherapy for Patients With Stage III Non-Small-cell Lung Cancer: A Phase I Study

The prominent role of alpha v beta 3/alpha v beta 5 integrin in radioresistance led to the design of the present phase I clinical trial combining the alpha v beta 3/alpha v beta 5 integrin inhibitor cilengitide, with exclusive chemoradiotherapy for patients with stage III nonesmall-cell lung cancer. Of the 14 included patients, 11 were evaluable for dose-limiting toxicities, of whom 1 had developed a tracheobronchial fistula at the third dose level. Overall, cilengitide showed acceptable toxicity with encouraging clinical results. These data suggest that integrins remain a potentially interesting therapeutic target in this field. Introduction: Because of our previous preclinical results, we conducted a phase I study associating the specific alpha v beta 3/alpha v beta 5 integrin inhibitor cilengitide, given as a continuous infusion, with exclusive chemoradiotherapy for patients with stage III non-small-cell lung cancer. Patients and Methods: A standard 3+3 dose escalation design was used. Cilengitide was given as a continuous infusion (dose levels of 12, 18, 27, and 40 mg/h), starting 2 weeks before and continuing for the whole course of chemoradiotherapy (66 Gy combined with platinum/vinorelbine), and then at a dose of 2000 mg twice weekly in association with chemotherapy. 2-Deoxy-2-[fluorine-18]fluoro-D-glucose positron emission tomography (PET) and computed tomography scans were performed before and after the first 2 weeks of cilengitide administration and then every 3 months. Results: Of the 14 patients included, 11 were evaluable for evaluation of the dose-limiting toxicities (DLTs). One DLT, a tracheobronchial fistula, was reported with the 40 mg/h dose. No relevant adverse events related to cilengitide were observed overall. At the PET evaluation 2 months after chemoradiotherapy, 4 of 9 patients had a complete response and 4 had a partial response. The median progression-free and overall survival was 14.4 months (95% confidence interval [CI], 8.4 to not reached) and 29.4 months (95% CI, 11.73 to not reached), respectively. Conclusion: Cilengitide, given continuously with chemoradiotherapy, showed acceptable toxicity and gave encouraging clinical results. (C) 2017 Elsevier Inc. All rights reserved.