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A Phase II Randomized Trial Of Surgery Followed By Chemoradiotherapy Plus Cetuximab For Advanced Squamous Cell Carcinoma Of The Head and Neck


Phase 2
18 Years
N/A
Open (Enrolling)
Both
Head and Neck Cancer

Thank you

Trial Information

A Phase II Randomized Trial Of Surgery Followed By Chemoradiotherapy Plus Cetuximab For Advanced Squamous Cell Carcinoma Of The Head and Neck


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.

Inclusion Criteria


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

Type of Study:

Interventional

Study Design:

Allocation: Randomized, Primary Purpose: Treatment

Outcome Measure:

Disease-free survival

Safety Issue:

No

Principal Investigator

Paul M. Harari, MD

Investigator Role:

Study Chair

Investigator Affiliation:

University of Wisconsin, Madison

Authority:

United States: Federal Government

Study ID:

CDR0000360850

NCT ID:

NCT00084318

Start Date:

April 2004

Completion Date:

Related Keywords:

  • Head and Neck Cancer
  • 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
  • Carcinoma
  • Carcinoma, Squamous Cell
  • Head and Neck Neoplasms

Name

Location

Akron City Hospital Akron, Ohio  44304
Roswell Park Cancer Institute Buffalo, New York  14263
Memorial Sloan-Kettering Cancer Center New York, New York  10021
Mayo Clinic Scottsdale Scottsdale, Arizona  85259
Mayo Clinic - Jacksonville Jacksonville, Florida  32224
Mayo Clinic Cancer Center Rochester, Minnesota  55905
Cardinal Bernardin Cancer Center at Loyola University Medical Center Maywood, Illinois  60153-5500
CCOP - Upstate Carolina Spartanburg, South Carolina  29303
Hurley Medical Center Flint, Michigan  48503
CCOP - Kansas City Kansas City, Missouri  64131
CCOP - Christiana Care Health Services Wilmington, Delaware  19899
CCOP - Mount Sinai Medical Center Miami Beach, Florida  33140
CCOP - Metro-Minnesota Saint Louis Park, Minnesota  55416
Veterans Affairs Medical Center - East Orange East Orange, New Jersey  07018-1095
Genesys Hurley Cancer Institute Flint, Michigan  48503
Bronson Methodist Hospital Kalamazoo, Michigan  49007
West Michigan Cancer Center Kalamazoo, Michigan  49007-3731
Borgess Medical Center Kalamazooaa, Michigan  49001
Fairview Ridges Hospital Burnsville, Minnesota  55337
Mercy and Unity Cancer Center at Mercy Hospital Coon Rapids, Minnesota  55433
Fairview Southdale Hospital Edina, Minnesota  55435
Mercy and Unity Cancer Center at Unity Hospital Fridley, Minnesota  55432
United Hospital St. Paul, Minnesota  55102
Ridgeview Medical Center Waconia, Minnesota  55387
Penn State Cancer Institute at Milton S. Hershey Medical Center Hershey, Pennsylvania  17033-0850
Gundersen Lutheran Cancer Center at Gundersen Lutheran Medical Center La Crosse, Wisconsin  54601
Medical College of Wisconsin Cancer Center Milwaukee, Wisconsin  53226
Massachusetts General Hospital Cancer Center Boston, Massachusetts  02114
Rapid City Regional Hospital Rapid City, South Dakota  57709
University of Alabama at Birmingham Comprehensive Cancer Center Birmingham, Alabama  35294-3300
Providence Saint Joseph Medical Center - Burbank Burbank, California  91505
CCOP - Bay Area Tumor Institute Oakland, California  94609-3305
Memorial Hospital of South Bend South Bend, Indiana  46601
Reading Hospital and Medical Center Reading, Pennsylvania  19612-6052
CCOP - MainLine Health Wynnewood, Pennsylvania  19096
CCOP - Greenville Greenville, South Carolina  29615
University of Wisconsin Comprehensive Cancer Center Madison, Wisconsin  53792
University of Colorado Cancer Center at University of Colorado Health Sciences Center Denver, Colorado  80010
University of Miami Sylvester Comprehensive Cancer Center Miami, Florida  33136
CCOP - Northern Indiana CR Consortium South Bend, Indiana  46601
CCOP - Grand Rapids Grand Rapids, Michigan  49503
Siteman Cancer Center at Barnes-Jewish Hospital Saint Louis, Missouri  63110
Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical Center Lebanon, New Hampshire  03756-0002
Charles M. Barrett Cancer Center at University Hospital Cincinnati, Ohio  45267-0526
Arthur G. James Cancer Hospital and Solove Research Institute at Ohio State University Columbus, Ohio  43210-1240
Kimmel Cancer Center at Thomas Jefferson University - Philadelphia Philadelphia, Pennsylvania  19107
CCOP - Scott and White Hospital Temple, Texas  76508
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Baltimore, Maryland  21231-2410
CCOP - St. Louis-Cape Girardeau Saint Louis, Missouri  63141
CCOP - Virginia Mason Research Center Seattle, Washington  98101
Utah Valley Regional Medical Center - Provo Provo, Utah  84604
Veterans Affairs Medical Center - Richmond Richmond, Virginia  23249
University of California Davis Cancer Center Sacramento, California  95817
Dana-Farber/Harvard Cancer Center at Dana Farber Cancer Institute Boston, Massachusetts  02115
Mobile Infirmary Medical Center Mobile, Alabama  36640-0460
Markey Cancer Center at University of Kentucky Chandler Medical Center Lexington, Kentucky  40536-0084
Cancer Research Center at Boston Medical Center Boston, Massachusetts  02118
Josephine Ford Cancer Center at Henry Ford Hospital Detroit, Michigan  48202
Thompson Cancer Survival Center Knoxville, Tennessee  37916
Blumenthal Cancer Center at Carolinas Medical Center Charlotte, North Carolina  28232-2861
Hulston Cancer Center at Cox Medical Center South Springfield, Missouri  65807
St. John's Regional Health Center Springfield, Missouri  65804
McDowell Cancer Center at Akron General Medical Center Akron, Ohio  44307
M.D. Anderson Cancer Center at University of Texas Houston, Texas  77030
Latter Day Saints Hospital Salt Lake City, Utah  84143
Loma Linda University Cancer Institute at Loma Linda University Medical Center Loma Linda, California  92354
Curtis & Elizabeth Anderson Cancer Institute at Memorial Health University Medical Center Savannah, Georgia  31403-3089
SUNY Upstate Medical University Hospital Syracuse, New York  13210
Mission Hospitals - Memorial Campus Asheville, North Carolina  28801
Hollings Cancer Center at Medical University of South Carolina Charleston, South Carolina  29425
St. Vincent Hospital Regional Cancer Center Green Bay, Wisconsin  54307-3508
Saint Peter's University Hospital New Brunswick, New Jersey  08901-1780
Mount Nittany Medical Center State College, Pennsylvania  16803
St. Mary's Hospital Medical Center - Green Bay Green Bay, Wisconsin  54303
Green Bay Oncology, Limited at St. Mary's Hospital Green Bay, Wisconsin  54303
Bay Area Cancer Care Center at Bay Area Medical Center Marinette, Wisconsin  54143
Torrance Memorial Medical Center Torrance, California  90505
Tallahassee Memorial Hospital Tallahassee, Florida  32308
Baptist Cancer Institute - Jacksonville Jacksonville, Florida  32207
Saint Anthony's Hospital at Saint Anthony's Health Center Alton, Illinois  62002
Good Samaritan Regional Health Center Mt. Vernon, Illinois  62864
Southeast Missouri Regional Cancer Center at Southeast Missouri Hospital Gape Girardeau, Missouri  63701
David C. Pratt Cancer Center at St. John's Mercy St. Louis, Missouri  63141
Wayne Memorial Hospital, Incorporated Goldsboro, North Carolina  27534
Cottonwood Hospital Medical Center Murray, Utah  84107
McKay-Dee Hospital Center Ogden, Utah  84403
Utah Cancer Specialists at UCS Cancer Center Salt Lake City, Utah  84106
University Cancer Center at University of Washington Medical Center Seattle, Washington  98195
Lakeland Cancer Care Center at Lakeland Hospital - St. Joseph Saint Joseph, Michigan  49085
Virginia Commonwealth University Massey Cancer Center Richmond, Virginia  23298-0037
Huntsman Cancer Institute at University of Utah Salt Lake City, Utah  84112
Elkhart General Hospital Elkhart, Indiana  46515
Fox Chase Virtua Health Cancer Program at Virtua Memorial Hospital Marlton Marlton, New Jersey  08053
Fox Chase Virtua Health Cancer Program at Virtua West Jersey Voorhees, New Jersey  08043
Hillcrest Cancer Center at Hillcrest Hospital Mayfield Heights, Ohio  44124
Rosenfeld Cancer Center at Abington Memorial Hospital Abington, Pennsylvania  19001
Fox Chase Cancer Center - Philadelphia Philadelphia, Pennsylvania  19111-2497
Michael & Dianne Bienes Comprehensive Cancer Center at Holy Cross Hospital Fort Lauderdale, Florida  33308
Ella Milbank Foshay Cancer Center at Jupiter Medical Center Jupiter, Florida  33458
Ingalls Cancer Care Center at Ingalls Memorial Hospital Harvey, Illinois  60426
Center for Cancer Therapy at LaPorte Hospital and Health Services La Porte, Indiana  46350
St. Joseph Mercy Cancer Center at St. Joseph Mercy Hospital Ann Arbor, Michigan  48106-0995
Upper Michigan Cancer Center at Marquette General Hospital Marquette, Michigan  49855
Virginia Piper Cancer Institute at Abbott-Northwestern Hospital Minneapolis, Minnesota  55407
Hubert H. Humphrey Cancer Center at North Memorial Medical Center Robbinsdale, Minnesota  55422-2900
Coborn Cancer Center Saint Cloud, Minnesota  56303
CentraCare Clinic - River Campus St. Cloud, Minnesota  56303
Park Nicollet Health Services St. Louis Park, Minnesota  55416
Saint Francis Medical Center Cape Girardeau, Missouri  63701
Iredell Memorial Hospital Statesville, North Carolina  28677
Forsyth Regional Cancer Center at Forsyth Medical Center Winston-Salem, North Carolina  27103
Bryn Mawr Hospital Bryn Mawr, Pennsylvania  19010
Lankenau Cancer Center at Lankenau Hospital Wynnewood, Pennsylvania  19096
Bon Secours St. Francis Health System Greenville, South Carolina  29601
Christine LaGuardia Phillips Cancer Center at Wellmont Holston Valley Medical Center Kingsport, Tennessee  37662
Dixie Regional Medical Center - East Campus Saint George, Utah  84770
Danville Regional Medical Center Danville, Virginia  24541
Green Bay Oncology, Limited at St. Vincent Hospital Green Bay, Wisconsin  54301-3526
Providence Holy Cross Cancer Center Mission Hills, California  91346-9600
H. Lee Moffitt Cancer Center and Research Institute at University of South Florida Tampa, Florida  33612
Northeast Georgia Medical Center Gainesville, Georgia  30501
Wendt Regional Cancer Center at Finley Hospital Dubuque, Iowa  52001
Tulane Cancer Center New Orleans, Louisiana  70112
Regional Cancer Center at Singing River Hospital Pascagoula, Mississippi  39581
All Saints Cancer Center at All Saints Healthcare Racine, Wisconsin  53405
John B. Amos Cancer Center Columbus, Georgia  31904
Leo W. Jenkins Cancer Center at ECU Medical School Greenville, North Carolina  27834
Guthrie Cancer Center at Guthrie Clinic Sayre Sayre, Pennsylvania  18840
York Cancer Center at Apple Hill Medical Center York, Pennsylvania  17405
St. Joseph Cancer Center Bellingham, Washington  98225
Schiffler Cancer Center at Wheeling Hospital Wheeling, West Virginia  26003
University of Minnesota Medical Center & Children's Hospital - Fairview Minneapolis, Minnesota  55455
Methodist Cancer Center at Methodist Hospital - Omaha Omaha, Nebraska  68114
Oregon Health & Science University Cancer Institute Portland, Oregon  97239-3098
Arizona Oncology Services Foundation Phoenix, Arizona  85013
Radiological Associates of Sacramento Medical Group, Incorporated Sacramento, California  95815
Hospital of Saint Raphael New Haven, Connecticut  06511
Good Samaritan Cancer Center at Good Samaritan Hospital Kearney, Nebraska  68848-1990
Long Island College Hospital Brooklyn, New York  11201
Mercy Cancer Institute at Mercy Hospital Pittsburgh, Pennsylvania  15219
Gibbs Regional Cancer Center at Spartanburg Regional Medical Center Spartanburg, South Carolina  29303
Dana-Farber/Brigham and Women's Cancer Center Boston, Massachusetts  02115
Cancer Institute at St. John's Hospital Springfield, Illinois  62701
Lacks Cancer Center at Saint Mary's Health Care Grand Rapids, Michigan  49503
Solano Radiation Oncology Center Vacaville, California  95687
Lynn Regional Cancer Center at Boca Raton Community Hospital - Main Center Boca Raton, Florida  33486
Mercy General Hospital Sacramento, California  95819
Virginia G. Piper Cancer Center at Scottsdale Healthcare - Shea Scottsdale, Arizona  85260
Virginia G. Piper Cancer Center at Scottsdale Healthcare - Osborn Scottsdale, Arizona  85251
Cancer Center of Paoli Memorial Hospital Paoli, Pennsylvania  19301-1792
Dale and Frances Hughes Cancer Center at Pocono Medical Center East Stroudsburg, Pennsylvania  18301
J. Phillip Citta Regional Cancer Center at Community Medical Center Toms River, New Jersey  08755
Cancer Institute of New Jersey at Cooper University Hospital - Camden Camden, New Jersey  08103
Hudner Oncology Center at Saint Anne's Hospital - Fall River Fall River, Massachusetts  02721
Auburn Radiation Oncology Auburn, California  95603
Radiation Oncology Centers - Cameron Park Cameron Park, California  95682
Radiation Oncology Center - Roseville Roseville, California  95661
Mercy Cancer Center at Mercy San Juan Medical Center Carmichael, California  95608
M.D. Anderson Cancer Center Orlando Orlando, Florida  32806
John D. Cronin Cancer Center Lexington, Kentucky  40504