Cervical Cancer
Conditions
Keywords
recurrent cervical cancer, cervical adenocarcinoma, cervical adenosquamous cell carcinoma, cervical small cell carcinoma, cervical squamous cell carcinoma, stage III cervical cancer, stage IVA cervical cancer, stage IVB cervical cancer
Brief summary
RATIONALE: Monoclonal antibodies, such as cetuximab, can block tumor growth in different ways. Some block the ability of tumor cells to grow and spread. Others find tumor cells and help kill them or carry tumor-killing substances to them. Cetuximab may also help cisplatin work better by making tumor cells more sensitive to the drug. Drugs used in chemotherapy, such as cisplatin, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Giving cetuximab together with cisplatin may be a better way to block tumor growth. PURPOSE: This phase II trial is studying how well giving cetuximab together with cisplatin works in treating patients with advanced, persistent, or recurrent cervical cancer.
Detailed description
OBJECTIVES: Primary * Determine the antitumor activity of cetuximab and cisplatin, in terms of objective tumor response (partial and complete), in patients with advanced, persistent, or recurrent carcinoma of the cervix. * Determine the nature and degree of toxicity of this regimen in these patients. Secondary * Determine the progression-free survival and overall survival of patients treated with this regimen. * Correlate epidermal growth factor receptor expression with progression-free survival, overall survival, and response in patients treated with this regimen. OUTLINE: This is a multicenter study. Patients receive cetuximab IV over 1-2 hours on days 1, 8, and 15 and cisplatin IV on days 1 and 8. Courses repeat every 21 days in the absence of unacceptable toxicity or disease progression. Patients are followed every 3 months for 2 years and then every 6 months for 3 years. PROJECTED ACCRUAL: A total of 28-62 patients will be accrued for this study within 9-20 months.
Interventions
Sponsors
Study design
Eligibility
Inclusion criteria
DISEASE CHARACTERISTICS: * Histologically confirmed squamous or non-squamous cell carcinoma of the cervix * Advanced, persistent, or recurrent disease * Documented disease progression * Not amenable to curative therapy * Measurable disease * At least 1 unidimensionally measurable lesion ≥ 20 mm by conventional techniques OR ≥ 10 mm by spiral CT scan * At least 1 target lesion * Tumors within a previously irradiated field are designated as non-target lesions unless progression is documented or a biopsy is obtained ≥ 90 days after completion of radiotherapy to confirm persistence PATIENT CHARACTERISTICS: Age * 18 and over Performance status * GOG 0-2 Life expectancy * Not specified Hematopoietic * Platelet count ≥ 100,000/mm\^3 * Absolute neutrophil count ≥ 1,500/mm\^3 Hepatic * Bilirubin ≤ 1.5 times upper limit of normal (ULN) * AST ≤ 2.5 times ULN * Alkaline phosphatase ≤ 2.5 times ULN Renal * Creatinine ≤ 1.5 times ULN Cardiovascular * No significant history of cardiac disease within the past 6 months, including the following: * Unstable angina * Uncontrolled hypertension * Uncontrolled congestive heart failure * Uncontrolled arrhythmia Neurologic * No uncontrolled seizure disorder * No active neurological disease * No neuropathy (sensory and motor) \> grade 1 Other * Not pregnant or nursing * Negative pregnancy test * Fertile patients must use effective contraception * No active infection requiring antibiotics * No other invasive malignancy within the past 5 years except nonmelanoma skin cancer PRIOR CONCURRENT THERAPY: Biologic therapy * No prior anti-epidermal growth factor receptor (EGFR) antibody therapy * No prior chimerized or murine monoclonal antibody therapy Chemotherapy * Not specified Endocrine therapy * At least 1 week since prior anticancer hormonal therapy * Concurrent hormone replacement therapy allowed Radiotherapy * See Disease Characteristics * At least 4 weeks since prior radiotherapy Surgery * More than 30 days since prior major surgery, except diagnostic biopsy Other * Recovered from all prior therapy * No prior cytotoxic therapy for cervical cancer * No prior tyrosine kinase inhibitor therapy that targets the EGFR pathway * No prior cancer treatment that would contraindicate study therapy * No other concurrent investigational agents
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Tumor Response | up to 6 months from study entry | Per GOG Response Evaluation Criteria In Solid Tumors(RECIST) Criteria: Complete Response(CR): disappearance of all target and non-target lesions and no evidence of new lesions documented by two disease assessments at least 4 weeks apart. Partial Response(PR): at least a 30% decrease in the sum of longest dimensions(LD) of all target measurable lesions taking as reference the baseline sum of LD. There can be no unequivocal progression of nontarget lesions and no new lesions. Increasing Disease: at least a 20% increase in the sum of LD of target lesions taking as references the smallest sum LD or the appearance of new lesions within 8 weeks of study entry. Stable Disease: any condition not meeting the above criteria. Indeterminate for response: as having no repeat tumor assessments following initiation of study therapy for reasons unrelated to symptoms or signs of disease. |
Secondary
| Measure | Time frame |
|---|---|
| Progression-free Survival and Overall Survival at 6 Months After Completion of Treatment | up to 5 years from study entry |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Cetuximab Cetuximab weekly (Cycle 1, day 1 initial loading dose of 400 mg/m2 IV. All subsequent Cetuximab doses are 250 mg/m2 IV) combined with Cisplatin on day 1 and day 8 (30 mg/m2) (one cycle will be three weeks) until disease progression or adverse effects prohibit further therapy. | 69 |
| Total | 69 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Ineligible | 6 |
| Overall Study | Inevaluable | 1 |
Baseline characteristics
| Characteristic | Cetuximab |
|---|---|
| Age, Continuous | 50.8 years STANDARD_DEVIATION 11.2 |
| Age, Customized 20-29 years | 1 participants |
| Age, Customized 30-39 years | 11 participants |
| Age, Customized 40-49 years | 18 participants |
| Age, Customized 50-59 years | 26 participants |
| Age, Customized 60-69 years | 9 participants |
| Age, Customized 70-79 years | 4 participants |
| Cell Type Adenocarcinoma, Unspecified | 21 participants |
| Cell Type Adenosquamous | 5 participants |
| Cell Type Clear Cell Carcinoma | 1 participants |
| Cell Type Mucinous Adenocarcinoma | 1 participants |
| Cell Type Squamous Cell Carcinoma | 41 participants |
| Region of Enrollment United States | 69 participants |
| Sex: Female, Male Female | 69 Participants |
| Sex: Female, Male Male | 0 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 66 / 69 |
| serious Total, serious adverse events | 33 / 69 |
Outcome results
Tumor Response
Per GOG Response Evaluation Criteria In Solid Tumors(RECIST) Criteria: Complete Response(CR): disappearance of all target and non-target lesions and no evidence of new lesions documented by two disease assessments at least 4 weeks apart. Partial Response(PR): at least a 30% decrease in the sum of longest dimensions(LD) of all target measurable lesions taking as reference the baseline sum of LD. There can be no unequivocal progression of nontarget lesions and no new lesions. Increasing Disease: at least a 20% increase in the sum of LD of target lesions taking as references the smallest sum LD or the appearance of new lesions within 8 weeks of study entry. Stable Disease: any condition not meeting the above criteria. Indeterminate for response: as having no repeat tumor assessments following initiation of study therapy for reasons unrelated to symptoms or signs of disease.
Time frame: up to 6 months from study entry
Population: Eligible and evaluable participants
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Cetuximab | Tumor Response | Complete Response | 1 participants |
| Cetuximab | Tumor Response | Partial Response | 7 participants |
| Cetuximab | Tumor Response | Increasing Disease | 17 participants |
| Cetuximab | Tumor Response | Stable Disease | 34 participants |
| Cetuximab | Tumor Response | Indeterminate | 10 participants |
Progression-free Survival and Overall Survival at 6 Months After Completion of Treatment
Time frame: up to 5 years from study entry