Description:
This pilot clinical trial studies cetuximab and radiation therapy in treating patients with
stage III-IV head and neck cancer. Monoclonal antibodies, such as cetuximab, may block tumor
growth in different ways by targeting certain cells. Radiation therapy uses high energy x
rays to kill tumor cells. Drugs used in chemotherapy, such as cisplatin, work in different
ways to stop the growth of tumor cells, either by killing the cells, by stopping them from
dividing, or by stopping them from spreading. Giving cetuximab or cisplatin together with
radiation therapy may kill more tumor cells.
Title
- Brief Title: Cetuximab and Radiation Therapy in Treating Patients With Stage III-IV Head and Neck Cancer
- Official Title: Selecting for Cetuximab Responders in Advanced Head and Neck SCC
Clinical Trial IDs
- ORG STUDY ID:
Pro20150001420
- SECONDARY ID:
NCI-2014-01303
- SECONDARY ID:
031204
- SECONDARY ID:
P30CA072720
- NCT ID:
NCT02177838
Conditions
- Stage III Squamous Cell Carcinoma of the Hypopharynx
- Stage III Squamous Cell Carcinoma of the Larynx
- Stage III Squamous Cell Carcinoma of the Oropharynx
- Stage III Verrucous Carcinoma of the Larynx
- Stage IV Squamous Cell Carcinoma of the Hypopharynx
- Stage IVA Squamous Cell Carcinoma of the Larynx
- Stage IVA Squamous Cell Carcinoma of the Oropharynx
- Stage IVA Verrucous Carcinoma of the Larynx
- Stage IVB Squamous Cell Carcinoma of the Larynx
- Stage IVB Squamous Cell Carcinoma of the Oropharynx
- Stage IVB Verrucous Carcinoma of the Larynx
- Tongue Cancer
Interventions
Drug | Synonyms | Arms |
---|
cetuximab | C225, C225 monoclonal antibody, IMC-C225, MOAB C225, monoclonal antibody C225 | Treatment (cetuximab, cisplatin, EBRT) |
cisplatin | CACP, CDDP, CPDD, DDP | Treatment (cetuximab, cisplatin, EBRT) |
Purpose
This pilot clinical trial studies cetuximab and radiation therapy in treating patients with
stage III-IV head and neck cancer. Monoclonal antibodies, such as cetuximab, may block tumor
growth in different ways by targeting certain cells. Radiation therapy uses high energy x
rays to kill tumor cells. Drugs used in chemotherapy, such as cisplatin, work in different
ways to stop the growth of tumor cells, either by killing the cells, by stopping them from
dividing, or by stopping them from spreading. Giving cetuximab or cisplatin together with
radiation therapy may kill more tumor cells.
Detailed Description
PRIMARY OBJECTIVES:
I. 2 year (yr) locoregional control in cetuximab responders.
SECONDARY OBJECTIVES:
I. Assess secondary clinical endpoints such as the percent of patients receiving neoadjuvant
cetuximab who progress by computed tomography (CT) Response Evaluation Criteria in Solid
Tumors (RECIST) 1.1 criteria during the neoadjuvant cetuximab, the 2 yr locoregional control
for non-responders to neoadjuvant cetuximab, and the complete response rate to positron
emission tomography (PET)/computed tomography (CT) scan 3 months after the completion of
radiation therapy for both responders and for non-responders to neoadjuvant cetuximab.
II. Analyze the relationship of known deoxyribonucleic acid (DNA) mutations in tumor per the
FoundationOne genomic profile, and correlate to clinical endpoints such as locoregional
control.
II. Analyze any changes in protein production at the tumor in response to 3 weeks of
cetuximab.
III. Analyze any changes in protein production at the skin in response to 3 weeks of
cetuximab.
IV. To investigate whether the tumor imaging characteristics including anatomical and
molecular parameters evaluated by PET/CT, either alone or combined with other biomarkers can
attribute to the better prediction for the clinical outcomes, as the response to neoadjuvant
cetuximab; and the final clinical endpoint, the 2-year local regional controls.
OUTLINE:
Patients receive cetuximab intravenously (IV) over 60-120 minutes for 3 weeks. Patients then
undergo external beam radiation therapy (EBRT) over 6-7 weeks. Patients achieving response
continue weekly doses of cetuximab until radiation therapy is completed. Patients unable to
achieve response or progression receive cisplatin IV over 1-2 hours on days 1, 22, and 43 of
radiation therapy.
After completion of study treatment, patients are followed up every 3 months for 2 years.
Trial Arms
Name | Type | Description | Interventions |
---|
Treatment (cetuximab, cisplatin, EBRT) | Experimental | Patients receive cetuximab IV over 60-120 minutes for 3 weeks. Patients then undergo EBRT over 6-7 weeks. Patients achieving response continue weekly doses of cetuximab until radiation therapy is completed. Patients unable to achieve response or progression receive cisplatin IV over 1-2 hours on days 1, 22, and 43 of radiation therapy. | |
Eligibility Criteria
Inclusion Criteria:
- Histologically proven squamous cell carcinoma of the oropharynx, hypopharynx or larynx
- Stage III/IVa/b squamous cell carcinoma (SCC) by American Joint Committee on Cancer
(AJCC) 7 criteria (advanced, but not metastatic)
- Patients must give informed consent
- Patients must have an Eastern Cooperative Oncology Group (ECOG) performance status =<
2
- Platelets >= 100,000/uL
- Absolute neutrophil count (ANC) >= 1,500/uL
- Hemoglobin > 8 g/dl (use of transfusion to achieve this is acceptable)
- Total bilirubin < 2 X institutional upper limit of normal (ULN)
- Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase
[SGOT])/alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT])
=< 3 X institutional ULN
- Serum creatinine < 2 x institutional ULN or creatinine clearance > 50 ml/min as
determined by 24 hour collection or estimated by Cockcroft-Gault formula
- Estimated life expectancy of at least 12 weeks
- Negative pregnancy test
Exclusion Criteria:
- Patients may not have received previous therapy for their head and neck SCC, including
chemotherapy, radiation therapy, or surgery beyond biopsy
- Second primary malignancy; exceptions are 1) patient had a second primary malignancy
but has been treated and disease free for at least 3 years, 2) in situ carcinoma (e.g.
in situ carcinoma of the cervix), 3) non-melanomatous carcinoma of the skin
- Patients with metastatic disease beyond the neck and supraclavicular region will be
excluded
- Serious concomitant systemic disorders (including active infections) that would
compromise the safety of the patient or compromise the patient's ability to complete
the study, at the discretion of the investigator; this includes scleroderma
- History of allergic reactions attributed to compounds of similar chemical or biologic
composition to cetuximab or cisplatinum or other agents used in the study
- Women who are pregnant; women of childbearing age must agree to undergo a pregnancy
test prior to therapy and to use adequate contraception (hormonal or barrier method of
birth control; abstinence) prior to study entry, for the duration of study
participation and for 6 months after; should a woman become pregnant or suspect she is
pregnant while participating in this study, she should inform her treating physician
immediately
- Patients with human immunodeficiency virus (HIV) infection are not automatically
excluded, but must meet the following criteria: cluster of differentiation (CD)4 count
is > 499/cu mm and their viral load is < 50 copies/ml; use of highly active
anti-retroviral therapy (HAART) is allowed
- Patients who have had either myocardial infarction, coronary artery bypass graft,
coronary artery stenting, hospital admission for heart related issues such as
congestive heart failure or arrhythmia within the last 3 months, will not be allowed
on protocol
- Grade 3-4 electrolyte abnormalities (Common Terminology Criteria for Adverse Events
[CTCAE], version [v]. 4):
- Serum calcium (ionized or adjusted for albumin) < 7 mg/dl (1.75 mmol/L) or > 12.5
mg/dl (> 3.1 mmol/L) despite intervention to normalize levels
- Magnesium < 0.9 mg/dl (< 0.4 mmol/L) or > 3 mg/dl (> 1.23 mmol/L) despite
intervention to normalize levels
- Potassium < 3.5 mmol/L or > 6 mmol/L despite intervention to normalize levels
- Sodium < 130 mmol/L or > 155 mmol/L despite intervention to normalize levels
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Locoregional Control in Cetuximab Responders |
Time Frame: | 2 years |
Safety Issue: | |
Description: | Target number of patients for the study was 27. At the termination of the study, 8 patients were accrued and finished treatment but 1 patient dropped out before follow up, leaving an evaluable number of 7. As the enrollment in the study did not reach the target number of patients, we were not able to produce statistically reliable results to detect the expected difference. Therefore, we have decided to provide summary statistics of primary and secondary outcomes.
Among 3 cetuximab responders, two did not have progression within 2 year follow-up time and one had a locoregional recurrence and expired. |
Secondary Outcome Measures
Measure: | Percent of Patients Who Progress During Neoadjuvant Cetuximab by CT RECIST 1.1 Criteria |
Time Frame: | Day 14-21 after the first dose of cetuximab |
Safety Issue: | |
Description: | Among 7 patients, no one progressed during neoadjuvant cetuximab per RECIST 1.1 CT criteria (0%). |
Measure: | Locoregional Control for Non-responders to Neoadjuvant Cetuximab |
Time Frame: | 2 years |
Safety Issue: | |
Description: | Among 4 cetuximab non-responders, none had locoregional failure at 2 years. Two patients had known HPV status; one patient was HPV+ and another patient HPV-. HPV status for the other two was unknown. HPV positive patient had no sign of progression within 2 years of follow-up. HPV negative patient had no sign of progression for 210 days until the last follow-up. One HPV unknown patient did not show progression within 2 years of follow-up, and the other HPV unknown patient had no progression for 115 days until the last follow-up. |
Details
Phase: | N/A |
Primary Purpose: | Interventional |
Overall Status: | Terminated |
Lead Sponsor: | Rutgers, The State University of New Jersey |
Last Updated
April 21, 2021