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Phase I/II Study on Induction Chemotherapy Followed by Chemoradiation With or Without Lapatinib, a Dual EGFR/ErbB2 Kinase Inhibitor, in Patients With Locally Advanced Larynx and Hypopharynx Squamous Cell Carcinoma


Phase 1/Phase 2
18 Years
N/A
Not Enrolling
Both
Head and Neck Cancer

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Trial Information

Phase I/II Study on Induction Chemotherapy Followed by Chemoradiation With or Without Lapatinib, a Dual EGFR/ErbB2 Kinase Inhibitor, in Patients With Locally Advanced Larynx and Hypopharynx Squamous Cell Carcinoma


OBJECTIVES:

Primary

- Determine the maximum tolerated dose and recommended dose for phase II of lapatinib
ditosylate in patients with locally advanced squamous cell carcinoma of the larynyx or
hypopharynx who are concomitantly treated with neoadjuvant induction chemotherapy
comprising docetaxel, cisplatin, and fluorouracil, followed by chemoradiotherapy
comprising carboplatin and radiotherapy. (Phase I)

- To document the feasibility, in the framework of an organ preservation program, of this
regimen in these patients. (Phase II)

Secondary

- To look at the role of PET in patients with N1-3 disease, in terms of PET being used as
a reliable method to spare patients from planned neck dissection. (Phase II)

OUTLINE: This is a multicenter, dose-escalation phase I study followed by a randomized phase
II study. Patients are stratified by institution and EGFR status (negative vs positive).

- Phase I:

- Neoadjuvant chemotherapy: Patients receive neoadjuvant chemotherapy comprising
docetaxel IV and cisplatin IV on day 1 and fluorouracil IV continuously on days
1-5. Treatment repeats every 21 days for up to 4 courses in the absence of disease
progression or unacceptable toxicity. Patients with a complete or partial response
after 4 courses of neoadjuvant chemotherapy proceed to chemoradiotherapy. Patients
with less than a partial response after course 2 or course 4 proceed to surgery,
including total laryngectomy.

- Chemoradiotherapy: Within 3 weeks after completion of neoadjuvant chemotherapy,
patients undergo radiotherapy on days 1-5, 8-12, 15-19, 22-26, 29-33, 36-40, and
43-47 and receive carboplatin IV on days 1, 8, 15, 22, 29, 36, and 43.

- Concurrent lapatinib ditosylate: Patients receive oral lapatinib ditosylate once
daily during neoadjuvant chemotherapy, during the break between neoadjuvant
chemotherapy and chemoradiotherapy, and during chemoradiotherapy.

- Phase II: Patients are randomized to 1 of 2 treatment arms.

- Arm I: Patients receive neoadjuvant chemotherapy and undergo chemoradiotherapy as
in phase I.

- Arm II: Patients receive neoadjuvant chemotherapy and undergo chemoradiotherapy as
in phase I. Patients also receive concurrent lapatinib ditosylate as in phase I at
the recommended dose determined in phase I.

In both phases, treatment continues in the absence of disease progression or unacceptable
toxicity.

Patients with node-positive disease (initially) undergo tumor and blood sample collection
for biological studies. Samples are analyzed for ErbB-related activation via
immunohistochemistry, in situ hybridization, and PCR/sequencing of genes/proteins, to detect
DNA amplification and polysomy (for AKT, ErbB2, EGFR) and genomic losses (for PTEN) via
FISH, and the ratio between EGFR and EGFRvIII via QRT-PCR. Patients with node-positive
disease undergo at least elective neck dissection to evaluate the negative predictive value
of PET scanning.

Patients are followed every 3 months for one year and then every 6 months thereafter.

Inclusion Criteria


DISEASE CHARACTERISTICS:

- Histologically confirmed newly diagnosed squamous cell carcinoma of the larynx or
hypopharynx

- T3 or T4 disease of the larynx or T2, T3 or T4 disease of the hypopharynx

- Nodal status must be N0, N1, N2a, N2b, N2c or N3

- Resectable or unresectable disease (Phase I patients only)

- Patient must have tumors amenable to surgery (Phase II patients only)

- No distant metastasis

PATIENT CHARACTERISTICS:

- WHO performance status 0-2

- Absolute neutrophil count ≥ 1,500/mm³

- Platelet count ≥ 100,000/mm³

- Bilirubin < 1.5 times the upper limit of the normal range

- Alkaline phosphatase and transaminases < 2.5 times the upper limit of the normal
range

- Serum creatinine < 1.7 mg/dL

- All patients (male and female) must use effective contraception methods if of
reproductive potential (e.g., implants, injectables, combined oral contraceptives,
IUDs, sexual abstinence, or vasectomized partner)

- Females must not be pregnant or lactating

- Patients must have normal cardiac function (LVEF assessed by MUGA or ECHO) and
clinically satisfactory 12-lead ECG

- No serious cardiac illness or medical condition within the past 6 months including,
but not limited to, any of the following:

- History of documented congestive heart failure

- High-risk uncontrolled arrhythmias

- Angina pectoris requiring antianginal medication

- Clinically significant valvular heart disease

- Evidence of transmural infarction on ECG

- Poorly controlled hypertension (e.g., systolic BP > 180 mm Hg or diastolic BP >
100 mm Hg)

- Patients should be able to swallow oral agents

- No current malignancies at other sites with the exception of cone biopsied carcinoma
of the cervix and adequately treated basal or squamous cell skin carcinoma or other
cancer from which the patient has been disease-free for at least five years

- Absence of any unstable systemic diseases or active uncontrolled infections

- Absence of any psychological, familial, sociological, or geographical condition
potentially hampering compliance with the study protocol and follow-up schedule

PRIOR CONCURRENT THERAPY:

- No other prior therapy for head and neck cancer

- More than 10 days since prior and no concurrent CYP3A4 inducers, including the
following:

- Antibiotics (e.g., all rifamycin class agents [rifampicin, rifabutin, or
rifapentine])

- Anticonvulsants (e.g., phenytoin, carbamezepine, or barbiturates
[phenobarbital])

- Oral glucocorticoids (e.g., cortisone [> 50 mg], hydrocortisone [> 40 mg],
prednisone [> 10 mg], methylprednisolone [> 8 mg], or dexamethasone [> 1.5 mg])

- Antiretrovirals (e.g., efavirenz or nevirapine)

- Other (hypericum perforatum [St. John's Wort] or modafinil)

- More than 10 days since prior and no concurrent CYP3A4 inhibitors, including the
following:

- Antibiotics (e.g., clarithromycin, erythromycin, or troleandomycin)

- Antifungals (e.g., itraconazole, ketoconazole, fluconazole [> 150 mg daily], or
voriconazole)

- Antiretrovirals and protease inhibitors (e.g., delavirdine, nelfinavir,
amprenavir, ritonavir, indinavir, saquinavir, or lopinavir)

- Calcium channel blockers (e.g., verapamil or diltiazem)

- Antidepressants (e.g., nefazodone or fluvoxamine)

- Gastrointestinal agents (e.g., cimetidine or aprepitant)

- Other (e.g., grapefruit, grapefruit juice, or camiodarone)

- Miscellaneous (e.g., antacids [Mylanta, Maalox, Tums, or Rennies], all herbal
[bergamottin or glabridin] or dietary supplements)

- Patients may not receive any other anticancer therapy or investigational agents while
on study

Type of Study:

Interventional

Study Design:

Allocation: Randomized, Masking: Open Label, Primary Purpose: Treatment

Outcome Measure:

Maximum tolerated dose of lapatinib ditosylate (Phase I)

Safety Issue:

Yes

Principal Investigator

Ahmad Awada, MD, PhD

Investigator Role:

Study Chair

Investigator Affiliation:

Institut Jules Bordet

Authority:

United States: Federal Government

Study ID:

EORTC-24051

NCT ID:

NCT00498953

Start Date:

May 2007

Completion Date:

March 2009

Related Keywords:

  • Head and Neck Cancer
  • stage II squamous cell carcinoma of the hypopharynx
  • stage III squamous cell carcinoma of the hypopharynx
  • stage IV squamous cell carcinoma of the hypopharynx
  • stage III squamous cell carcinoma of the larynx
  • stage IV squamous cell carcinoma of the larynx
  • Laryngeal Neoplasms
  • Carcinoma, Squamous Cell
  • Head and Neck Neoplasms

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