Description:
This is a single arm Phase II study for patients with recurrent or metastatic squamous cell
carcinoma of the head and neck, who are previously treated with a platinum based regimen or
with an immune checkpoint inhibitor. The primary objective is to evaluate the efficacy of the
combination of cetuximab and afatinib.
Title
- Brief Title: Dual Inhibition of EGFR With Afatinib and Cetuximab in the Treatment of Advanced Squamous Cell Cancers of the Head and Neck
- Official Title: Single-Arm Phase II Trial of Dual Inhibition of EGFR With Afatinib and Cetuximab With Correlative Studies in the Treatment of Advanced Squamous Cell Cancers of the Head and Neck
Clinical Trial IDs
- ORG STUDY ID:
1608018260
- NCT ID:
NCT02979977
Conditions
- Squamous Cell Cancers of the Head and Neck
Interventions
Drug | Synonyms | Arms |
---|
cetuximab | Erbitux | All subjects |
afatinib | GIOTRIF or GILOTRIF | All subjects |
Purpose
This is a single arm Phase II study for patients with recurrent or metastatic squamous cell
carcinoma of the head and neck, who are previously treated with a platinum based regimen or
with an immune checkpoint inhibitor. The primary objective is to evaluate the efficacy of the
combination of cetuximab and afatinib.
Detailed Description
This study will be a multicenter, single-arm, open-label Phase II trial. Patients with
advanced squamous cell carcinoma of the head and neck, who are previously treated with a
platinum based regimen or with immune checkpoint inhibitor therapy or both, will be eligible
for participation on the study. After a baseline evaluation and biopsy (where feasible), they
will be treated with weekly/bi-weekly intravenous cetuximab and daily oral afatinib. Biopsy
will be repeated where feasible after 4 weeks (window of +1 week) on therapy and again at
disease progression or end of treatment.
Treatment will continue until disease progression or development of Grade 3 or higher drug
related toxicities that fail to resolve to Grade 2 despite appropriate supportive care.
Trial Arms
Name | Type | Description | Interventions |
---|
All subjects | Experimental | Advanced squamous cell carcinoma of the head and neck region, having previously been treated on a platinum based regimen or with an immune checkpoint inhibitor. Subjects will receive Afatinib dose 30 mg per day and weekly/bi-weekly intravenous cetuximab. | |
Eligibility Criteria
Inclusion Criteria:
- Histologically confirmed squamous cell carcinoma of the head and neck that is
metastatic, recurrent or locally advanced and not treatable with curative intent.
- Previous treatment with a platinum-based regimen or immune checkpoint inhibitor or
both.2-week washout period prior to treatment start will be required.
- Patients who have experienced progression of disease within 6 months following
completion of a platinum-based chemoradiation in the definitive or adjuvant setting
will be permitted.
- Prior cetuximab permitted if it was given as part of multi-modality therapy for
initial treatment of locally advanced disease.
- Measurable disease based on RECIST v 1.1. Baseline measurements and evaluations must
be obtained within 4 weeks of enrollment. Disease in previously irradiated sites is
considered measurable if there has been unequivocal disease progression or
biopsy-proven residual carcinoma following radiation therapy.
- ECOG performance status ≤2
- Adequate organ function, defined as all of the following:
- Hemoglobin ≥ 8 g/dl.
- Absolute neutrophil count (ANC) ≥1000 / mm3.
- Platelet count ≥75,000 / mm3.
- Estimated creatinine clearance > 45ml / min.
- Total Bilirubin ≤ 1.5 times upper limit of (institutional/central) normal (Patients
with Gilbert's syndrome total bilirubin must be ≤4 times institutional upper limit of
normal).
- Aspartate amino transferase (AST) or alanine amino transferase (ALT) ≤ three times the
upper limit of (institutional/central) normal (ULN) (if related to liver metastases ≤
five times ULN).
- Ability to understand and the willingness to sign a written informed consent that is
consistent with ICH-GCP guidelines.
- Negative urine or serum pregnancy test for women of childbearing potential
Exclusion Criteria:
- Prior erlotinib, gefitinib or lapatinib therapy or prior exposure to any
investigational EGFR or panErbB reversible or irreversible inhibitor or any prior
panitumumab or investigational EGFR-directed monoclonal antibody.
- Radiotherapy within 2 weeks prior to enrollment. Palliative radiation to target organs
may be allowed up to 2 weeks prior to enrollment, as long as there are other target
lesions that can be monitored for response to study treatment.
- Known hypersensitivity to afatinib or its excipients
- Women of child-bearing potential (WOCBP) and men who are able to father a child,
unwilling to be abstinent or use highly effective methods of birth control prior to
study entry, for the duration of study participation and for at least 4 weeks after
treatment has ended.
- Women who are pregnant, nursing, or who plan to become pregnant while in the trial.
- Any history of or concomitant condition that, in the opinion of the Investigator,
would compromise the patient's ability to comply with the study or interfere with the
evaluation of the efficacy and safety of the test drug.
- Concomitant malignancies at other sites that are being actively treated with systemic
therapy
- Requiring treatment with any of the prohibited concomitant medications that cannot be
stopped for the duration of trial participation.
- Clinically significant interstitial lung disease.
- Known history of untreated viral hepatitis or HIV.
- Patients with parenchymal brain metastases are not eligible, unless they have
completed local therapy
- Leptomeningeal carcinomatosis
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Tumor shrinkage |
Time Frame: | Disease progression or end of treatment (up to 2 years) |
Safety Issue: | |
Description: | Objective Response Rate (Complete Response + Partial Response), defined by tumor shrinkage (mm), per Response Evaluation Criteria in Solid Tumors (RECIST) v1.1. |
Secondary Outcome Measures
Measure: | Progression-free survival in weeks |
Time Frame: | 1 year follow-up |
Safety Issue: | |
Description: | We will use Kaplan-Meier survival analysis to estimate the median PFS in the cohort. |
Measure: | Overall survival in months |
Time Frame: | 1 year follow-up |
Safety Issue: | |
Description: | Measured by a monthly phone calls. We will use Kaplan-Meier survival analysis to estimate the median and OS in the cohort. |
Measure: | Duration of response in weeks |
Time Frame: | 1 year follow-up |
Safety Issue: | |
Description: | |
Measure: | Toxicity assessed with National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 |
Time Frame: | Up to 2.5 years |
Safety Issue: | |
Description: | |
Details
Phase: | Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | Yale University |
Last Updated
May 6, 2021