Description:
This is a non-randomized, open-label phase II trial of 38 patients with recurrent or
metastatic SCCHN. Patients must have an Eastern Cooperative Oncology Group (ECOG) performance
status of 0-1 with good organ function and will be treated with six weekly cycles of
carboplatin, paclitaxel and cetuximab. Following assessment of response, the treating
physician at their discretion may continue to treat with weekly cetuximab as maintenance
until disease progression. The study is designed to evaluate whether this regimen improves
median overall survival (OS) as compared to an historical control population treated with a
platinum plus 5-fluorouracil (5-FU). There is currently no agreed upon first line therapy for
recurrent or metastatic SCCHN; regimen options are highly toxic, inconvenient and resource
intensive. Our study regimen has been used extensively for induction therapy and off-protocol
in palliative care, but treatment outcomes have yet to be defined by a clinical trial.
Title
- Brief Title: Weekly Carboplatin, Paclitaxel and Cetuximab Treatment for Patients With Recurrent or Metastatic SCCHN
- Official Title: LCCC 1330 - A Phase II Study of Weekly Carboplatin, Paclitaxel and Cetuximab for Patients With Recurrent or Metastatic Squamous Cell Carcinoma of the Head and Neck (SCCHN)
Clinical Trial IDs
- ORG STUDY ID:
LCCC 1330
- NCT ID:
NCT02124707
Conditions
- Head and Neck Cancer
- Squamous Cell Carcinoma of the Head and Neck
Interventions
Drug | Synonyms | Arms |
---|
Cetuximab | Erbitux | Carboplatin, Paclitaxel and Cetuximab |
Paclitaxel | Taxol | Carboplatin, Paclitaxel and Cetuximab |
Carboplatin | Paraplatin | Carboplatin, Paclitaxel and Cetuximab |
Purpose
This is a non-randomized, open-label phase II trial of 38 patients with recurrent or
metastatic SCCHN. Patients must have an Eastern Cooperative Oncology Group (ECOG) performance
status of 0-1 with good organ function and will be treated with six weekly cycles of
carboplatin, paclitaxel and cetuximab. Following assessment of response, the treating
physician at their discretion may continue to treat with weekly cetuximab as maintenance
until disease progression. The study is designed to evaluate whether this regimen improves
median overall survival (OS) as compared to an historical control population treated with a
platinum plus 5-fluorouracil (5-FU). There is currently no agreed upon first line therapy for
recurrent or metastatic SCCHN; regimen options are highly toxic, inconvenient and resource
intensive. Our study regimen has been used extensively for induction therapy and off-protocol
in palliative care, but treatment outcomes have yet to be defined by a clinical trial.
Detailed Description
Because of their high response rates and low toxicity, the taxane, carboplatin, cetuximab
regimens have frequently been adapted for use in the palliative setting. At UNC, we have
observed high rates of response, leading to symptomatic benefit and low toxicity. Further,
the regimen de-medicalizes the patient's life in several important ways. First, unlike with
the EXTREME regimen, no PORT or 4 day infusion is required. Second, the regimen gives only
six weeks of cytotoxic therapy. Finally, in our experience there is a low rate of severe
toxicity and this, coupled with the high rate of response, may improve quality of life. We
are not aware of any presented or published results on the use of this combination in
palliative therapy; with the adoption of this regimen in clinical practice, documentation of
its benefit via conduct of a clinical trial is needed.
We propose a study designed to detect an improvement in median OS versus a historical
control. The control arm from the EXTREME trial achieved a median OS of 7.4 months. We
hypothesize that a less toxic and more effective 3-drug regimen will result in improved
median OS compared with the control arm from EXTREME (median 7.4 months). The toxicity
associated with EXTREME is primarily attributable to the cisplatin and 5FU cytotoxic backbone
as its toxicity has been consistent in multiple studies of both palliative therapy and
induction therapy. If a 4-month improvement in OS is achieved with acceptable toxicity, we
will consider this regimen worth of further study.
Secondary objectives will include characterizing changes in quality of life (QoL), symptoms
and toxicities. Patients will be encouraged to co-enroll into the UNCseq protocol for further
exploration of associations between genetic changes and clinical outcomes.
Trial Arms
Name | Type | Description | Interventions |
---|
Carboplatin, Paclitaxel and Cetuximab | Experimental | A 6 week course of weekly carboplatin, paclitaxel, and cetuximab will be administered to 38 patients with recurrent or metastatic squamous cell carcinoma of the head and neck (SCCHN). Once protocol therapy is complete, cetuximab may be continued if the patient and physician agree. Within 3 weeks of the end of protocol therapy, response will be assessed, and if the patient has achieved at least stable disease, the treating physician may continue to treat with weekly cetuximab at their discretion until disease progression. Patients will be followed for a maximum of 3 years after the end of the 6 week treatment phase. | - Cetuximab
- Paclitaxel
- Carboplatin
|
Eligibility Criteria
Inclusion Criteria:
- Age ≥ 18 years old
- Histologically or cytologically confirmed recurrent or metastatic Squamous Cell
Carcinoma of the Head and Neck (SCCHN). All primary sites are eligible excluding WHO
type III or EBV nasopharyngeal (WHO type I and WHO type II allowed as long as they are
EBV negative)
- ECOG performance status 0-1
- Adequate organ and marrow function as defined below. Laboratory tests should be
completed within 14 days prior to registration: ANC greater than or equal to
1,500/mm3, Platelets greater than or equal to 100,000/mm3, HgB greater than 9g/dL
(acceptable to reach this by transfusion), Total bilirubin less than or equal to
1.5mg/dL, Albumin greater than 2.5 g/dL, AST(SGOT)/ALT(SGPT) less than or equal to
2.5X institutional upper limit of normal, alkaline phosphatase less than or equal to
2.5 x upper limit of normal, GFR greater than 30 mL/min (by standard Cockroft and
Gault formula or measured via 24 hour urine collection)
- Women of childbearing potential (WOCBP) with negative serum or urine pregnancy test
within 7 days of D1 of treatment
- WOCBP and men must agree to use adequate contraception prior to study entry and for
duration of treatment under this protocol; adequate contraception is defined as any
medically recommended method (or combination of methods) per standard of care.
- Cancer must be considered incurable by the treating clinician
- Ability to understand and willingness to sign a written informed consent document
Exclusion Criteria:
- History of prior cumulative exposure to > 300mg/m2 cisplatin, AUC of 18 of
carboplatin, or their combined equivalent within one year prior to enrollment
- Surgery or radiation within the four weeks prior to D1 of treatment under this
protocol
- Prior systemic chemotherapy unless it was part of definitive-intent (curative intent)
treatment more than 6 months before study entry
- Other active, invasive malignancy requiring ongoing therapy or expected to require
systemic therapy within two years; localized squamous cell carcinoma of the skin,
basal-cell carcinoma of the skin, carcinoma in-situ of the cervix, or other
malignancies requiring locally ablative therapy only will not result in exclusion
- Pregnant or lactating female
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Median Overall Survival |
Time Frame: | 36 months |
Safety Issue: | |
Description: | Overall survival after treatment with weekly carboplatin, paclitaxel and cetuximab for 6 weeks with or without the addition of maintenance weekly cetuximab is defined as the time from D1 of treatment under this protocol until death as a result of any cause. |
Secondary Outcome Measures
Measure: | Median Progression Free Survival |
Time Frame: | 36 months |
Safety Issue: | |
Description: | Progression events will be defined per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.1), as a 20% increase in the sum of the longest diameter of target lesions, or a measurable increase in a non-target lesion, or the appearance of new lesions Progression free survival after treatment with weekly carboplatin, paclitaxel and cetuximab for 6 weeks with or without the addition of maintenance weekly cetuximab is defined as the time from Day 1 of treatment until progression or death as a result of any cause. |
Measure: | Overall Response Rate by Participants |
Time Frame: | 6 weeks |
Safety Issue: | |
Description: | Number of complete response (CR) and partial response (PR) after study treatment with weekly carboplatin, paclitaxel, and cetuximab for 6 weeks. Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.1) for target lesions and assessed by CT scan: CR is defined as disappearance of all target lesions; and PR as >=30% decrease in the sum of the longest diameter of target lesions |
Measure: | Incidence of Adverse Events |
Time Frame: | 18 weeks |
Safety Issue: | |
Description: | Grade 3 and 4 toxicities associated with this combined chemotherapy regimen as assessed by clinician assessment using the NCI Common Terminology Criteria for Adverse Events,a descriptive terminology which can be utilized for Adverse Event (AE) reporting. A grading (severity) scale is provided for each AE term. Grade 3 Severe or medically significant but not immediately life-threatening; hospitalization or prolongation of hospitalization indicated; disabling; limiting self care Activities of daily living (ADL). Grade 4 Life-threatening consequences; urgent intervention indicated. Describe patient reported symptoms associated with this regimen. |
Measure: | Head and Neck Quality of Life Assessments |
Time Frame: | Baseline, End of treatment (EOT), First follow-up visit (8-12 weeks after EOT) |
Safety Issue: | |
Description: | Quality of life (QOL) as measured by the Functional Assessment of Cancer Therapy - Head and Neck (FACT-HN) questionnaire. The FACT-HN is the FACT-General (FACT-G) and a head and neck cancer specific, 12 item subscale given at baseline, at end of treatment, and at first follow-up visit. The FACT-G is a 27 item measure of general QOL assessing function in 4 domains: physical well-being (PWB), social-family well-being (SFWB), emotional well-being (EWB) and functional well-being (FWB). Items are rated by patients on a Likert scale from 0 to 4, with all subscales summed to give a total score with a range of 0-148 Higher scores represent better QOL. |
Details
Phase: | Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Completed |
Lead Sponsor: | UNC Lineberger Comprehensive Cancer Center |
Trial Keywords
- Head and neck cancer
- Squamous cell carcinoma
- Metastatic
- Recurrent
- Phase II
- Carboplatin
- Paclitaxel
- Cetuximab
Last Updated
August 12, 2020