Head and Neck Cancer
Conditions
Keywords
stage IV squamous cell carcinoma of the hypopharynx, stage IV squamous cell carcinoma of the larynx, stage IV squamous cell carcinoma of the lip and oral cavity, stage IV squamous cell carcinoma of the oropharynx
Brief summary
RATIONALE: Monoclonal antibodies such as cetuximab can locate tumor cells and either kill them or deliver tumor-killing substances to them without harming normal cells. Drugs used in chemotherapy, such as cisplatin, work in different ways to stop tumor cells from dividing so they stop growing or die. Radiation therapy uses high-energy x-rays to damage tumor cells. Cetuximab may make the tumor cells more sensitive to radiation therapy and chemotherapy. Giving monoclonal antibody therapy together with chemoradiotherapy may kill more tumor cells. PURPOSE: This phase II trial is studying how well giving cetuximab and cisplatin together with radiation therapy works in treating patients with locally advanced or regional stage IV head and neck cancer that cannot be removed by surgery.
Detailed description
OBJECTIVES: Primary * Determine 2-year progression-free survival in patients with unresectable locally advanced or regional stage IV squamous cell or undifferentiated carcinoma of the head and neck treated with cetuximab, cisplatin, and definitive radiotherapy. Secondary * Determine response rate and overall survival in patients treated with this regimen. * Determine the toxic effects of this regimen in these patients. * Correlate epidermal growth factor receptor (EGFR) expression by immunohistochemistry, EGFR phosphorylation, map kinase, Akt, signal transducer and activator of transcription 3 (STAT3), and other tissue and serum tests with toxicity of this regimen and outcomes in these patients. OUTLINE: This is a multicenter study. Patients are stratified according to tumor site (hypopharynx vs. oropharynx vs. oral cavity vs. larynx), primary tumor stage (T1-3 vs. T4), and nodal status (N0 vs. N1 vs. N2-3). * Cetuximab therapy: Patients receive an initial loading dose of cetuximab IV over 2 hours on day 1. Patients then receive cetuximab IV over 1 hour on days 8, 15, 22, 29, 36, 43, 50, and 57. * Chemoradiotherapy: Beginning on day 15 of cetuximab therapy, patients undergo radiotherapy once daily, 5 days a week, for at least 7 weeks. Patients also receive cisplatin IV over 1-2 hours on days 15, 36, and 57. * Cetuximab maintenance therapy: After the completion of chemoradiotherapy, patients continue to receive cetuximab IV over 1 hour once weekly for 6-12 months. Treatment continues in the absence of disease progression or unacceptable toxicity. Patients are followed every 6 months for 10 years. ACCRUAL: A total of 69 patients were accrued for this study.
Interventions
BIOLOGICALcetuximab C225
400 mg/m\^2 IV over 120 minutes on Day 1, 250 mg/m\^2 IV over 60 minutes on Day 8, then weekly
DRUGcisplatin
75 mg/m\^2 IV over 30-60 minutes starting day 15 every 3 weeks \* 3 (Days 1, 22, and 43 of radiation therapy (RT))
RADIATIONradiation therapy
RT 70 Gy / 35 starting Day 15, 200cGy / d \* 7 weeks (35 fractions)
Sponsors
National Cancer Institute (NCI)
Eastern Cooperative Oncology Group
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Histologically confirmed squamous cell or undifferentiated carcinoma of the head and neck (excluding nasopharynx, paranasal sinus, and parotid gland) * Unresectable locally advanced or regional stage IV disease * No evidence of distant metastases * Must have demonstrable primary tumor site * Measurable disease * Unresectable disease * Meets the following criteria for unresectable disease by tumor site: * Hypopharynx, meeting 1 of the following criteria: * Extension across the midline of the posterior pharyngeal wall * Any evidence of fixation to the cervical spine * Larynx * Direct subglottic extension (\>3cm) into surrounding muscle or skin * Oral cavity * Lesion precluding functional reconstruction * Base of tongue, meeting 1 of the following criteria: * Extension into the root of the tongue * Patient refuses total glossectomy * Tonsillar area, meeting 1 of the following criteria: * Extension into pterygoid area as manifested by x-ray or trismus * Extension across midline of pharyngeal wall * Direct extension into soft tissue of the neck * Unilateral neck node metastases fixed to carotid artery, mastoid, base of skull, or cervical spine with any of the above tumors * Patients requiring total glossectomy are eligible * Age\>=18 years * ECOG Performance status of 0-1 * Adequate hematologic, renal, and hepatic function obtained \<=4 weeks prior to registration * Absolute neutrophil count ≥ 2,000/mm\^3 * Platelet count ≥ 100,000/mm\^3 * Hemoglobin ≥ 9.0 g/dL * Alkaline phosphatase ≤ 3 times normal * Aspartate aminotransferase (AST) or Alanine aminotransferase (ALT) ≤ 3 times normal * Bilirubin ≤ 1.5 mg/dL * Creatinine ≤ 1.2 mg/dL OR creatinine clearance ≥ 50 mL/min * Able to tolerate fluid load * At least 14 days since major surgery (including dental extraction) except percutaneous endoscopic gastrostomy (PEG) placement or mediport placement
Exclusion criteria
* Pregnant or nursing * Fertile patients do not use effective contraception * Patients who refuse surgery but whose tumors are technically resectable OR whose tumors are unresectable for medical reasons are not eligible * Disease metastases below the clavicles or elsewhere (M1) or with a postoperative recurrence * Prior excisional surgery of head and neck tumor * Prior radiotherapy to the head and neck region * Prior chemotherapy * Prior drugs that target the epidermal growth factor receptor pathway * Prior chimerized or murine monoclonal antibody * Active systemic infection * Known allergy to murine proteins * Severe chronic obstructive pulmonary disease requiring ≥ 3 hospitalizations within the past year * Myocardial infarction within the past 3 months * Uncontrolled congestive heart failure * Unstable or uncontrolled angina * Clinically apparent jaundice * Postoperative recurrence * Other malignancy within the past 3 years except resected basal cell or squamous cell skin cancer, carcinoma in situ of the cervix, or other in situ tumors
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| 2-year Progression-free Survival Rate | assessed every 3 months for 2 years | Two-year progression-free survival rate was defined as the proportion of patients that were alive progression-free two years after registration into the study. Disease progression was assessed per modified RECIST criteria, and defined as at least a 20% increase in the sum of the longest diameters of target lesions, in either primary or nodal lesions, taking as reference the smallest sum longest diameter recorded since the baseline measurements, or the appearance of new lesions. Kaplan-Meier estimate of 2-year progression-free survival was calculated in the 60 eligible and treated patients. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| 2-year Overall Survival Rate | assessed very 3 months for 2 years | Overall survival was defined as time from registration to death from any cause. Patients alive at last follow-up were censored. The 2-year overall survival rate was defined as the percentage of patients that were still alive two years after registration into the study. Kaplan-Meier estimate of 2-year overall survival was calculated in the 60 eligible and treated patients. |
| Overall Response Rate | assessed after all chemoradiation therapy completed Week 9, then every 3 months on C225 maintenance therapy, and every 3 months for 2 years, every 6 months post-treatment 2 years from study entry | Response was assessed per Response Evaluation in Solid Tumor (RECIST) criteria by physical assessment and CT. Overall response = complete response (CR) + partial response (PR). CR was defined as the disappearance of all target and non-target lesions. PR was defined as at least a 30% decrease in the sum of the longest diameters of target lesions, along with non-progressive disease of non-target lesions. Overall response rate (i.e., proportion of patients who had CR or PR) and the corresponding 90% confidence intervals were calculated for the 60 eligible and treated patients |
Participant flow
Recruitment details
The study was open to accrual on 12/21/2004, accrued its first patient on April 8, 2005, and was closed on 07/20/2006. The final accrual was 69 patients.
Participants by arm
| Arm | Count |
|---|---|
| Cisplatin, C225, Radiation * Cetuximab therapy: Patients receive an initial loading dose of cetuximab intravenously (IV) over 2 hours on day 1. Patients then receive cetuximab IV over 1 hour on days 8, 15, 22, 29, 36, 43, 50, and 57.
* Chemoradiotherapy: Beginning on day 15 of cetuximab therapy, patients undergo radiotherapy once daily, 5 days a week, for at least 7 weeks. Patients also receive cisplatin IV over 1-2 hours on days 15, 36, and 57.
* Cetuximab maintenance therapy: After the completion of chemoradiotherapy, patients continue to receive cetuximab IV over 1 hour once weekly for 6-12 months. | 60 |
| Total | 60 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Adverse Event | 15 |
| Overall Study | Death | 6 |
| Overall Study | Ineligible | 6 |
| Overall Study | Lack of Efficacy | 9 |
| Overall Study | Not started protocol therapy | 3 |
| Overall Study | other reason | 8 |
| Overall Study | Withdrawal by Subject | 15 |
Baseline characteristics
| Characteristic | Cisplatin, C225, Radiation |
|---|---|
| Age, Continuous | 54.8 years |
| Region of Enrollment United States | 60 participants |
| Sex: Female, Male Female | 9 Participants |
| Sex: Female, Male Male | 51 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 66 / 66 |
| serious Total, serious adverse events | 64 / 66 |
Outcome results
Primary
2-year Progression-free Survival Rate
Two-year progression-free survival rate was defined as the proportion of patients that were alive progression-free two years after registration into the study. Disease progression was assessed per modified RECIST criteria, and defined as at least a 20% increase in the sum of the longest diameters of target lesions, in either primary or nodal lesions, taking as reference the smallest sum longest diameter recorded since the baseline measurements, or the appearance of new lesions. Kaplan-Meier estimate of 2-year progression-free survival was calculated in the 60 eligible and treated patients.
Time frame: assessed every 3 months for 2 years
Population: Eligible and treated
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Cisplatin, C225, Radiation | 2-year Progression-free Survival Rate | 47 proportion of participants |
Secondary
2-year Overall Survival Rate
Overall survival was defined as time from registration to death from any cause. Patients alive at last follow-up were censored. The 2-year overall survival rate was defined as the percentage of patients that were still alive two years after registration into the study. Kaplan-Meier estimate of 2-year overall survival was calculated in the 60 eligible and treated patients.
Time frame: assessed very 3 months for 2 years
Population: Eligible and treated
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Cisplatin, C225, Radiation | 2-year Overall Survival Rate | 66 proportion of participants |
Secondary
Overall Response Rate
Response was assessed per Response Evaluation in Solid Tumor (RECIST) criteria by physical assessment and CT. Overall response = complete response (CR) + partial response (PR). CR was defined as the disappearance of all target and non-target lesions. PR was defined as at least a 30% decrease in the sum of the longest diameters of target lesions, along with non-progressive disease of non-target lesions. Overall response rate (i.e., proportion of patients who had CR or PR) and the corresponding 90% confidence intervals were calculated for the 60 eligible and treated patients
Time frame: assessed after all chemoradiation therapy completed Week 9, then every 3 months on C225 maintenance therapy, and every 3 months for 2 years, every 6 months post-treatment 2 years from study entry
Population: Eligible and treated
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Cisplatin, C225, Radiation | Overall Response Rate | 66.7 proportion of participants |