Adjuvant Cetuximab and Chemoradiotherapy Using Either Cisplatin or Docetaxel in Treating Patients With Resected Stage III or Stage IV Squamous Cell Carcinoma or Lymphoepithelioma of the Head and Neck
Recruitment status was Active, not recruiting
- Full Text View
- Tabular View
- No Study Results Posted
- Disclaimer
- How to Read a Study Record
Purpose
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 and docetaxel, 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. Cisplatin and docetaxel may make the tumor cells more sensitive to radiation therapy. Combining a monoclonal antibody with chemoradiotherapy and giving them after surgery may kill any remaining tumor cells.
PURPOSE: This randomized phase II trial is studying adjuvant cetuximab given together with chemoradiotherapy using cisplatin to see how well it works compared to adjuvant cetuximab given together with chemoradiotherapy using docetaxel in treating patients with resected stage III or stage IV squamous cell carcinoma (cancer) or lymphoepithelioma of the head and neck.
| Condition | Intervention | Phase |
|---|---|---|
|
Head and Neck Cancer |
Biological: cetuximab Drug: cisplatin Drug: docetaxel Procedure: adjuvant therapy Radiation: radiation therapy |
Phase 2 |
| Study Type: | Interventional |
| Study Design: | Allocation: Randomized Primary Purpose: Treatment |
| Official Title: | A Phase II Randomized Trial Of Surgery Followed By Chemoradiotherapy Plus Cetuximab For Advanced Squamous Cell Carcinoma Of The Head and Neck |
- Disease-free survival [ Designated as safety issue: No ]
- Treatment tolerance [ Designated as safety issue: Yes ]
- Frequency of toxicity (grade 5 and acute non-hematologic grade 4) [ Designated as safety issue: Yes ]
- Frequency of other acute and late toxicity [ Designated as safety issue: Yes ]
- Overall survival [ Designated as safety issue: No ]
- Local-regional control [ Designated as safety issue: No ]
- Correlation of EGFR (total and phosphorylated) pMAPK, pAKT, Stat-3, KI-67, COX-2, and cyclin B1 expression with local-regional control, and overall and disease-free survival [ Designated as safety issue: No ]
| Estimated Enrollment: | 230 |
| Study Start Date: | April 2004 |
OBJECTIVES:
Primary
- Compare disease-free survival of patients with resected stage III or IV squamous cell carcinoma or lymphoepithelioma of the head and neck treated with adjuvant cetuximab in combination with chemoradiotherapy comprising docetaxel vs cisplatin.
Secondary
- Compare the safety and efficacy of these regimens in these patients.
- Compare locoregional control and overall survival rates in patients treated with these regimens.
- Correlate epidermal growth factor receptor (total and phosphorylated), pMAPK, pAKT, Stat-3, Ki-67, cyclo-oxygenase-2, and cyclin B1 expression with outcome in patients treated with these regimens.
OUTLINE: This is a randomized, multicenter study. Patients are stratified according to Zubrod performance status (0 vs 1), risk category (positive margins vs high risk [i.e., ≥ 2 positive nodes or extracapsular nodal extension]) and use of intensity-modulated radiotherapy (no vs yes). Patients are randomized to 1 of 2 treatment arms.
- Arm I: Patients receive cetuximab IV over 2 hours on day 1 (week 1). Patients then receive cetuximab IV over 1 hour and cisplatin IV over 1 hour before radiotherapy on days 8, 15, 22, 29, 36, and 43 (weeks 2-7). Patients undergo radiotherapy once daily, 5 days a week, beginning on day 8 for a total of 6 weeks (weeks 2-7).
- Arm II: Patients receive cetuximab and undergo radiotherapy as in arm I. Patients also receive docetaxel IV over 30 minutes before radiotherapy on days 8, 15, 22, 29, 36, and 43 (weeks 2-7).
Treatment in both arms continues in the absence of disease progression or unacceptable toxicity.
Patients are followed every 3 months for 2 years and then every 6 months for 4 years, and then annually thereafter.
PROJECTED ACCRUAL: A total of 230 patients (115 per treatment arm) will be accrued for this study within approximately 29 months.
Eligibility| Ages Eligible for Study: | 18 Years and older |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
DISEASE CHARACTERISTICS:
Histologically confirmed squamous cell carcinoma of the head and neck meeting the following criteria:
- Site of tumor origin in the oral cavity, oropharynx, larynx, or hypopharynx (excluding lip, nasopharynx, or sinuses)
Gross total resection must be completed within 7 weeks of randomization, with pathology demonstrating one or more of the following risk factors:
- Histologic extracapsular nodal extension
- Histologic involvement of ≥ 2 regional lymph nodes
- Invasive cancer seen on microscopic evaluation of the resection margin, with no evidence of gross tumor residual. or lymphoepithelioma of the oral cavity, oropharynx, larynx, or hypopharynx
- Tonsillar cancer patients who undergo transoral excision of all gross tumor are eligible provided extracapsular nodal extension or involvement of ≥ 2 regional lymph nodes is histologically confirmed
- Stage III or IV disease after gross total resection completed within the past 7 weeks
- No evidence of distant metastases
- No synchronous or concurrent head and neck primary tumors
PATIENT CHARACTERISTICS:
Age
- 18 and over
Performance status
- Zubrod 0-1
Life expectancy
- Not specified
Hematopoietic
- Absolute neutrophil count ≥ 2,000/mm^3
- Platelet count ≥ 100,000/mm^3
- Hemoglobin > 8.0 g/dL
Hepatic
- Bilirubin ≤ 1.5 times upper limit of normal (ULN)
AST or ALT, and alkaline phosphatase meeting 1 of the following parameters:
- Alkaline phosphatase ≤ ULN AND AST or ALT ≤ 5 times ULN
- Alkaline phosphatase ≤ 2.5 times ULN AND AST or ALT ≤ 1.5 times ULN
- Alkaline phosphatase ≤ 5 times ULN AND AST or ALT ≤ ULN
Renal
- Creatinine ≤ 1.5 mg/dL
Cardiovascular
- No unstable angina
- No uncontrolled hypertension
- No myocardial infarction within the past 6 months (unless successfully treated with coronary artery bypass surgery or percutaneous transluminal coronary angioplasty)
- No uncontrolled arrhythmia
- No congestive heart failure
- No more than 2 heart-related hospitalizations within the past year
- No other active cardiac disease
Pulmonary
- No more than 2 hospitalizations for chronic obstructive pulmonary disease within the past year
Neurologic
- No pre-existing peripheral neuropathy ≥ grade 2
- No uncontrolled seizure disorder
- No active neurological disease
Other
- No prior severe hypersensitivity reaction to docetaxel or other drugs formulated with polysorbate 80
- No other invasive malignancy within the past 3 years except nonmelanoma skin cancer
- No other concurrent illness that would preclude study participation
- No concurrent psychiatric illness that would preclude study participation
- No other concurrent physical condition (e.g., infectious disease) that would preclude study participation
- No prisoners
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception during and for 3 months after study participation
PRIOR CONCURRENT THERAPY:
Biologic therapy
- No prior anti-epidermal growth factor receptor antibody therapy
Chemotherapy
- More than 3 years since prior cytotoxic chemotherapy
Endocrine therapy
- Not specified
Radiotherapy
- No prior head and neck radiotherapy
- No concurrent intensity-modulated radiotherapy
Surgery
- See Disease Characteristics
Other
- No prior tyrosine kinase inhibitor therapy
Contacts and Locations
Show 160 Study Locations| Study Chair: | Paul M. Harari, MD | University of Wisconsin, Madison |
| Investigator: | Merrill S. Kies, MD | M.D. Anderson Cancer Center |
| Investigator: | Jeffrey N. Myers, MD, PhD, FACS | M.D. Anderson Cancer Center |
More Information
Additional Information:
Publications:
| ClinicalTrials.gov Identifier: | NCT00084318 History of Changes |
| Obsolete Identifiers: | NCT00414674 |
| Other Study ID Numbers: | CDR0000360850, RTOG-0234 |
| Study First Received: | June 10, 2004 |
| Last Updated: | February 22, 2011 |
| Health Authority: | United States: Federal Government |
Keywords provided by National Cancer Institute (NCI):
|
stage III squamous cell carcinoma of the hypopharynx stage IV squamous cell carcinoma of the hypopharynx stage III squamous cell carcinoma of the oropharynx stage IV squamous cell carcinoma of the oropharynx |
stage III squamous cell carcinoma of the larynx stage IV squamous cell carcinoma of the larynx stage III lymphoepithelioma of the oropharynx stage IV lymphoepithelioma of the oropharynx |
Additional relevant MeSH terms:
|
Carcinoma Carcinoma, Squamous Cell Head and Neck Neoplasms Neoplasms, Glandular and Epithelial Neoplasms by Histologic Type Neoplasms Neoplasms, Squamous Cell Neoplasms by Site Adjuvants, Immunologic |
Docetaxel Cetuximab Cisplatin Immunologic Factors Physiological Effects of Drugs Pharmacologic Actions Antineoplastic Agents Therapeutic Uses Radiation-Sensitizing Agents |
ClinicalTrials.gov processed this record on May 22, 2013