Cabazitaxel - PF Induction Chemotherapy
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Purpose
The primary objective of this study is to determine the first-cycle maximum tolerated dose (MTD) and recommended Phase II (RP2D) dose of Cabazitaxel when combined with Cisplatin and Follow-Up induction chemotherapy in patients with locally advanced squamous cell carcinoma of the head and neck for three cycles.
| Condition | Intervention | Phase |
|---|---|---|
|
Squamous Cell Carcinoma of the Head and Neck |
Drug: Cabazitaxel 10mg/m2 Drug: Cabazitaxel 12.5mg/m2 Drug: Experimental: Cabazitaxel 15mg/m2 Drug: Experimental: Cabazitaxel 17.5mg/m2 Drug: Cabazitaxel 20mg/m2 |
Phase 1 |
| Study Type: | Interventional |
| Study Design: | Allocation: Non-Randomized Endpoint Classification: Safety/Efficacy Study Intervention Model: Factorial Assignment Masking: Open Label Primary Purpose: Treatment |
| Official Title: | Phase I Study of Cabazitaxel - Platinum Fluorouracil Induction Chemotherapy in Patients With Locally Advanced Squamous Cell Carcinoma of the Head and Neck |
- Maximum Tolerated Dose (MTD) [ Time Frame: at 3 weeks ] [ Designated as safety issue: Yes ]MTD is defined as the dose level immediately below the DLT. The study will be conducted until MTD and recommended Phase II dose are established.
- Maximum Tolerated Dose (MTD) [ Time Frame: at 6 weeks ] [ Designated as safety issue: Yes ]MTD is defined as the dose level immediately below the DLT. The study will be conducted until MTD and recommended Phase II dose are established.
- Maximum Tolerated Dose (MTD) [ Time Frame: at 9 weeks ] [ Designated as safety issue: Yes ]MTD is defined as the dose level immediately below the DLT. The study will be conducted until MTD and recommended Phase II dose are established.
- Dose-limiting toxicity (DLT) [ Time Frame: at 3 weeks ] [ Designated as safety issue: Yes ]DLT is defined as a grade3 toxicity lasting more than 7 days or grade 4 or 5 toxicity, with the exception of febrile neutropenia which will be considered as ½ DLT per full dose per episode. The DLT will be the basis for determining the MTD. Treatment cohorts will be dosed in escalating order only after the safety of the previous dose level is established, or until an MTD has been determined.
- Dose-limiting toxicity (DLT) [ Time Frame: at 6 weeks ] [ Designated as safety issue: Yes ]DLT is defined as a grade3 toxicity lasting more than 7 days or grade 4 or 5 toxicity, with the exception of febrile neutropenia which will be considered as ½ DLT per full dose per episode. The DLT will be the basis for determining the MTD. Treatment cohorts will be dosed in escalating order only after the safety of the previous dose level is established, or until an MTD has been determined.
- Dose-limiting toxicity (DLT) [ Time Frame: at 9 weeks ] [ Designated as safety issue: Yes ]DLT is defined as a grade3 toxicity lasting more than 7 days or grade 4 or 5 toxicity, with the exception of febrile neutropenia which will be considered as ½ DLT per full dose per episode. The DLT will be the basis for determining the MTD. Treatment cohorts will be dosed in escalating order only after the safety of the previous dose level is established, or until an MTD has been determined.
- Toxicity Profile [ Time Frame: at 9 weeks ] [ Designated as safety issue: Yes ]The toxicity profile of cabazitaxel when comined with cisplatin and FU induction chemotherapy will be assessed
- Overall Response Rate [ Time Frame: at 9 weeks ] [ Designated as safety issue: No ]The Best Overall Response Rate (complete and partial responses) will be assessed after completion of 3 cycles of treatment.
- Progression Free Survival/Overall Survival [ Time Frame: for 3 years ] [ Designated as safety issue: No ]The Progression Free Survival and Overall Survival will be assessed during the 3-year follow-up period. The follow-up period is every 3 months for the first 2 years post consolidation (week 16) thereafter every 6 months for the 3rd year post consolidation (week 16).
| Estimated Enrollment: | 40 |
| Study Start Date: | April 2011 |
| Estimated Study Completion Date: | April 2014 |
| Estimated Primary Completion Date: | April 2014 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
Experimental: Cabazitaxel 10mg/m2
|
Drug: Cabazitaxel 10mg/m2
Other Name: Cabazitaxel-PF Induction Chemotherapy
|
Experimental: Cabazitaxel 12.5mg/m2
|
Drug: Cabazitaxel 12.5mg/m2
Other Name: Cabazitaxel-PF Induction Chemotherapy
|
Experimental: Cabazitaxel 15mg/m2
|
Drug: Experimental: Cabazitaxel 15mg/m2
Other Name: Cabazitaxel-PF Induction Chemotherapy
|
Experimental: Cabazitaxel 17.5mg/m2
|
Drug: Experimental: Cabazitaxel 17.5mg/m2
Other Name: Cabazitaxel-PF Induction Chemotherapy
|
Experimental: Cabazitaxel 20mg/m2
|
Drug: Cabazitaxel 20mg/m2
Other Name: Cabazitaxel-PF Induction Chemotherapy
|
Detailed Description:
The primary study objectives are the following:
- To assess the safety, the maximum tolerated dose (MTD) and the dose limiting toxicity of cabazitaxel when combined with cisplatin and Follow-Up (FU) induction chemotherapy in patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN).
- To establish the phase II recommended dose of cabazitaxel when combined with cisplatin and Follow-Up induction in patients with locally advanced squamous cell carcinoma of the head and neck.
The secondary study objectives, in regards to the combined Cabazitaxel-Platinum Fluorouracil regimen in patients with newly diagnosed squamous cell carcinoma of the head and neck, are the following:
- To assess the toxicity profile
- To assess best Overall Response Rate (complete and partial responses) after completion of 3 cycles of treatment
- To assess Progression Free Survival (PFS) and Overall Survival (OS) after 3 years Analysis of the secondary variables will be primarily descriptive in nature due to the small sample size. All results will be considered hypothesis generating to be confirmed in a future study.
Patient, for whom an informed consent has been obtained and who have met the inclusion/exclusion criteria after having the screening evaluation performed within a one-week window, will be assigned to a dose level according to the dose escalation rule described in the protocol. Treatment consists of an Induction chemotherapy period, which is the period when the patient will undergo 3 cycles of Cabazitaxel-Platinum Fluorouracil (PF). The Induction chemotherapy will be followed by Consolidation Therapy, which is 6-7 weeks of Chemoradiation treatment or Surgery + Recovery time, depending on their primary site and overall medical condition. Both treatment periods will consist of approximately 16 weeks (9 weeks of Induction and 7 weeks of Consolidation, if Chemoradiation Radiation Therapy (CRT)), or shorter than 16 weeks, if surgery. After three cycles, the patients will be assessed for clinical, radiographic, and pathologic response to Cabazitaxel-Platinum Fluorouracil before beginning Chemoradiation Radiation Therapy or surgery. Patients, who do not complete three cycles of Cabazitaxel-Platinum Fluorouracil for reasons of toxicity, progressive disease, choice, or other medical necessity, will be treated with standard Chemoradiation Radiation Therapy or surgery depending on their primary site and overall medical condition. Once the Consolidation treatment is completed, the follow-up of patients will be for 3 years.
Eligibility| Ages Eligible for Study: | 18 Years and older |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Patients with stage IV only, previously untreated, locally advanced SCCHN (patients may have had previous surgery, but not chemotherapy or radiotherapy).
- During the dose escalation phase before the MTD and DLT are established for cabazitaxel combined with cisplatin and FU induction chemotherapy primary sites allowed include the oral cavity, oropharynx, larynx, hypopharynx, nasopharynx, and unknown primary regardless of Human Papilloma Virus (HPV) status. Metastatic SCCHN will be allowed in escalation phase.
- Once MTD and DLT for cabazitaxel combined with cisplatin and FU induction chemotherapy are established (expansion cohort) primary sites allowed include the oral cavity, oropharynx (HPV negative only), larynx, hypopharynx, nasopharynx, and unknown primary (HPV negative only). No patients with metastases will be allowed in this phase (expansion cohort).
- Age >/= 18 years
- Eastern Cooperative Oncology Group PS 0-1
- Predicted life expectancy >/= 12 weeks
- Absolute Neutrophilc Count (ANC) >/= 1.5 x 10^9/L, Platelets >/= 100 x 10^9/L; bilirubin </= 1.5 x Upper Limit of Normal (ULN), Aspartate Aminotransferase (AST) and/or Alanine Aminotransferase (ALT) </= 2.5 x ULN or </= 5 x ULN if patient has documented liver metastases; serum creatinine </= 1.5 x ULN
- Patients in the expansion cohorts must have measurable disease per Response Evaluation Criteria in Solid Tumors(RECIST)
- Patients must be accessible for repeat dosing and follow-up
- Patients - both males and females - with reproductive potential must agree to practice effective contraceptive measures throughout the study. Women of childbearing potential must provide a negative pregnancy test at baseline and on Day 1
- Patients must provide verbal and written informed consent to participate in the study
Exclusion Criteria:
- Locally advanced HPV positive oropharyngeal or unknown primary SCCHN for the expansion cohort only (Once MTD and DLT for cabazitaxel combined with cisplatin and FU induction chemotherapy established).
- History of significant cardiac disease unless the disease is well-controlled
- Grade 2 peripheral neuropathy
- No excessive alcohol consumption will be allowed
- Serious comorbid illness, and involuntary weight loss of more than 20% of body weight in the 3 months preceding study entry
- History of cerebrovascular accident (CVA) within 12 months prior to registration or that is not stable
- History of any psychiatric condition that might impair the patient's ability to understand or to comply with the requirements of the study or to provide informed consent
- Pregnant or breast-feeding females Gastrointestinal (GI) abnormalities including inability to take oral medication, requirement for IV alimentation, active peptic ulcer, or prior surgical procedures affecting absorption
- History of allergic reactions attributed to compounds of similar chemical or biologic composition to the study drug
- Any type of active seizure disorder
- Use of drugs that have a risk of causing QT interval prolongation within 14 days prior to Day 1 dosing
- Use of strong or moderate CYP3A4 or CYP1A2 inhibitors/inducers, with the exception of low-dose steroids, within 14 days prior to Day 1 dosing
- Symptomatic brain metastases that are not stable, require steroids, or that have required radiation within the last 28 days
- Active or uncontrolled infections or serious illnesses or medical conditions that could interfere with the patient's ongoing participation in the study
- History of Hepatitis C or Human Immunodeficiency Virus (HIV) infection, autoimmune disease, or major organ transplant.
- Surgery, irradiation or chemotherapy within the previous 4 weeks
- Any other concomitant anticancer therapies
- Patients will be excluded if they received any prior chemotherapy, radiotherapy, or treatment with biologic response modifiers (except curatively treated basal or squamous cell carcinoma of the skin or carcinoma in situ of the cervix)
- History of colitis or chronic diarrheal illness
- History of, or active, co-morbid medical condition, which in the opinion of the investigator, would raise significant risk to the patient.
Contacts and Locations| Contact: Nadia Camille | (212) 241-5253 | nadia.camille@mountsinai.org |
| Contact: Madeleine Schrier | (212) 825-7310 | madeleine.schrier@mssm.edu |
| United States, New York | |
| Mount Sinai School of Medicine | Recruiting |
| New York, New York, United States, 10029 | |
| Principal Investigator: Krzysztof Misiukiewicz, MD | |
| Sub-Investigator: Marshall Posner, MD | |
| Principal Investigator: | Krzysztof Misiukiewicz, M.D. | Mount Sinai School of Medicine |
More Information
Publications:
| Responsible Party: | Krzysztof Misiukiewicz, Assistant Professor, Mount Sinai School of Medicine |
| ClinicalTrials.gov Identifier: | NCT01379339 History of Changes |
| Other Study ID Numbers: | 11-0646(0001)(01), 183133-96-2 |
| Study First Received: | June 15, 2011 |
| Last Updated: | November 1, 2011 |
| Health Authority: | United States: Institutional Review Board |
Keywords provided by Mount Sinai School of Medicine:
|
Cabazitaxel Cabazitaxel and Cisplatin Phase I PF Induction Chemotherapy |
Squamous Cell Carcinoma Head and Neck Sanofi-Aventis Oncology Locally Advanced |
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 Cisplatin Fluorouracil |
Antineoplastic Agents Therapeutic Uses Pharmacologic Actions Radiation-Sensitizing Agents Physiological Effects of Drugs Antimetabolites Molecular Mechanisms of Pharmacological Action Antimetabolites, Antineoplastic Immunosuppressive Agents Immunologic Factors |
ClinicalTrials.gov processed this record on May 22, 2013