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A Randomized Phase II Trial of Chemoradiotherapy Versus Chemoradiotherapy and Vandetanib for High-Risk Postoperative Advanced Squamous Cell Carcinoma of the Head and Neck


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

Thank you

Trial Information

A Randomized Phase II Trial of Chemoradiotherapy Versus Chemoradiotherapy and Vandetanib for High-Risk Postoperative Advanced Squamous Cell Carcinoma of the Head and Neck


OBJECTIVES:

Primary

- To screen for an indication that the addition of vandetanib to chemoradiotherapy may
prolong disease-free survival as compared to a combination of chemoradiotherapy in
patients with resected, high-risk stage III or IV head and neck squamous cell
carcinoma.

Secondary

- To determine whether this treatment regimen can be delivered safely and successfully
following surgical resection for advanced head and neck cancer.

- To estimate the locoregional progression, distant metastasis, and overall survival
rates for patients treated with this regimen.

- To examine the distribution of selected biomarkers that may include but are not limited
to EGFR (epidermal growth factor receptor, total and phosphorylated), E-cadherin, pMAPK
(phosphorylated mitogen-activated protein kinase), pAKT, Stat-3 (signal transducer and
activator of transcription 3), Ki-67, COX-2 (cyclooxygenase 2), and cyclin B1
(G2/mitotic-specific cyclin-B1)expression in this group of patients and to explore the
potential correlation between these markers with the ultimate treatment outcome

OUTLINE: This is a multicenter study. Patients are stratified according to Zubrod
performance status (0 vs 1) and primary site of disease (oral cavity/hypopharynx vs larynx
vs oropharynx, HPV+ (human papillomavirus positive) vs oropharynx, HPV- (human
papillomavirus negative)). Patients are randomized to 1 of 2 arms.

- Arm I: Patients undergo radiotherapy 5 times a week for up to 6.5 weeks and receive
cisplatin IV over 1 hour on days 1, 22, and 43 of radiotherapy.

- Arm II: Patients undergo radiotherapy as in arm I and receive cisplatin IV over 1 hour
once a week beginning on day 1 of radiotherapy. Patients also receive oral vandetanib
once daily beginning 14 days prior to the start of radiotherapy.

In both arms, treatment continues for 6 weeks in the absence of disease progression or
unacceptable toxicity.

Tissue samples from all patients are collected and reviewed. Tissue from patients with
oropharyngeal carcinoma is analyzed for human papillomavirus.

After completion of study treatment, patients are followed every 3 months for 2 years, every
6 months for 4 years, and then annually thereafter.

Inclusion Criteria


DISEASE CHARACTERISTICS:

- Histologically or cytologically confirmed squamous cell carcinoma of the head and
neck, including any of the following subtypes:

- Oral cavity

- Oropharynx

- Larynx

- Hypopharynx

- Stage III or IV disease (no distant metastases)

- No cancer of the lip, nasopharynx, or sinuses

- Must have undergone gross total resection* (with curative intent) within 3-6 weeks of
registration, with pathology demonstrating 1 or more of the following risk factors:

- Histologic extracapsular nodal extension

- Invasive cancer seen on microscopic evaluation of the resection margin, when all
visible tumor has been removed NOTE: *Tonsillar cancer patients who undergo
transoral excision of all gross tumor are eligible if the patient has formal
neck dissection confirming histologic extracapsular nodal extension

PATIENT CHARACTERISTICS:

Inclusion criteria:

- Zubrod performance status 0-1

- ANC (absolute neutrophil count) ≥ 2,000/mm³

- Platelet count ≥ 100,000/mm³

- Hemoglobin ≥ 8.0 g/dL (transfusion or other intervention to achieve this level
allowed)

- Total bilirubin normal

- AST (aspartate aminotransferase) or ALT (alanine amino transferase) ≤ 2 times upper
limit of normal (ULN)

- Alkaline phosphatase ≤ 2.5 times ULN

- Serum creatinine ≤ 1.5 mg/dL

- Creatinine clearance ≥ 60 mL/min

- Glucose ≥ 40 mg/dL AND ≤ 250 mg/dL

- Sodium ≥ 130 mmol/L AND ≤ 155 mmol/L

- Magnesium ≥ 0.9 mg/dL AND ≤ 3 mg/dL (supplementation allowed)

- Potassium ≥ 4 mmol/L AND ≤ 6 mmol/L (supplementation allowed)

- Serum calcium (ionized or adjusted for albumin) ≥ 7 mg/dL AND ≤ 12.5 mg/dL
(supplementation allowed)

- QTc (corrected QT interval) interval ≥ 480 msec must have 2 additional EKGs ≥ 24 hrs
apart and the average QTc from the 3 screening EKGs must be < 480 msec

- Not pregnant or nursing

- Negative pregnancy test

- Fertile patients must use effective contraception during and for at least 60 days
after completion of study treatment

- May not donate blood during the study or for 3 months after last dose of vandetanib

Exclusion criteria:

- Other simultaneous primary cancer

- Prior invasive malignancy (except nonmelanoma skin cancer) unless disease free for a
minimum of 3 years with the exception of the following:

- Carcinoma in situ of the cervix

- Adequately treated basal cell or squamous cell carcinoma of the skin

- Untreated or treated low-risk prostate cancer (defined as clinical or pathologic
T1c, N0 M0, PSA (prostate-specific antigen) < 10, Gleason < 7, < 50% of the
total cores positive for cancer)

- Severe, active co-morbidity, defined as follows:

- Clinically significant cardiovascular event (e.g., myocardial infarction,
superior vena cava syndrome, or New York Heart Association class II-IV) or
presence of cardiac disease that, in the opinion of the investigator, increases
the risk of ventricular arrhythmia within the past 3 months

- Unstable angina and/or congestive heart failure requiring hospitalization within
the past 3 months

- Transmural myocardial infarction within the past 3 months

- History of arrhythmia (e.g., multifocal premature ventricular contractions,
bigeminy, trigeminy, ventricular tachycardia, or uncontrolled atrial
fibrillation) which is symptomatic or requires treatment (CTCAE [Common
Terminology Criteria for Adverse Events] grade 3), or asymptomatic sustained
ventricular tachycardia

- Patients with atrial fibrillation, controlled on medication, are eligible

- Presence of left bundle branch block

- Previous history of QTc prolongation as a result from other medication that
required discontinuation of that medication

- Congenital long QTc syndrome or first degree relative with unexplained sudden
death under 40 years of age

- QTc with Bazett's correction that is unmeasurable or ≥ 480 msec on screening EKG

- Patients who are receiving a drug that has a risk of QTc prolongation are
not eligible if QTc is ≥ 460 msec

- Hypertension (systolic blood pressure [BP] > 160 mm Hg or diastolic BP > 100 mm
Hg) not controlled by medical therapy

- Diarrhea ≥ grade 1 (increase of < 4 stools per day over baseline or mild
increase in ostomy output compared to baseline)

- Acute bacterial or fungal infection requiring intravenous antibiotics at the
time of registration

- Chronic obstructive pulmonary disease exacerbation or other respiratory illness
requiring hospitalization or precluding study therapy within the past 30 days

- Hepatic insufficiency resulting in clinical jaundice and/or coagulation defects

- Acquired Immune Deficiency Syndrome (AIDS) based upon current CDC (Center for
Disease Control) definition (no HIV testing is required for study entry)

- Prior allergic reaction to cisplatin or vandetanib or derivatives similar to these
drugs

PRIOR CONCURRENT THERAPY:

- See Disease Characteristics

- No prior systemic chemotherapy for this disease (prior chemotherapy for a different
cancer allowed)

- No prior radiotherapy to the head and neck area that would result in overlap of
radiotherapy fields

- More than 30 days since prior investigational agents

- More than 3 weeks since prior major surgery and recovered

- More than 2 weeks since prior and no concurrent medications that induce Torsades de
Pointes

- More than 2 weeks since prior and no concurrent known potent inducers of CYP3A4
(Cytochrome P450 3A4), including rifampicin, phenytoin, carbamazepine, barbiturates,
and Hypericum perforatum (St. John wort)

- No concurrent medication that may cause QTc prolongation

Type of Study:

Interventional

Study Design:

Allocation: Randomized, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment

Outcome Measure:

Disease-free Survival

Outcome Description:

This study terminated early with 34 subjects accrued out of 170 planned, therefore no analyses were performed.

Outcome Time Frame:

From randomization to date of failure (local, regional, or distant progression, or death) or last follow-up. Analysis occurs after 78 failures have been reported.

Safety Issue:

No

Principal Investigator

David Raben, MD

Investigator Role:

Principal Investigator

Investigator Affiliation:

University of Colorado, Denver

Authority:

United States: Food and Drug Administration

Study ID:

CDR0000599867

NCT ID:

NCT00720083

Start Date:

November 2008

Completion Date:

August 2011

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 larynx
  • stage IV squamous cell carcinoma of the larynx
  • stage III verrucous carcinoma of the oral cavity
  • stage IV verrucous carcinoma of the oral cavity
  • stage III squamous cell carcinoma of the oropharynx
  • stage IV squamous cell carcinoma of the oropharynx
  • Carcinoma, Squamous Cell
  • Head and Neck Neoplasms

Name

Location

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
Barbara Ann Karmanos Cancer Institute Detroit, Michigan  48201
CCOP - Kansas City Kansas City, Missouri  64131
CCOP - Christiana Care Health Services Wilmington, Delaware  19899
Methodist Cancer Center at Methodist Hospital Indianapolis, Indiana  46202
Case Comprehensive Cancer Center Cleveland, Ohio  44106-5065
Medical College of Wisconsin Cancer Center Milwaukee, Wisconsin  53226
Rapid City Regional Hospital Rapid City, South Dakota  57709
Kimmel Cancer Center at Thomas Jefferson University - Philadelphia Philadelphia, Pennsylvania  19107
Cleveland Clinic Taussig Cancer Center Cleveland, Ohio  44195
USC/Norris Comprehensive Cancer Center and Hospital Los Angeles, California  90033-0804
Rebecca and John Moores UCSD Cancer Center La Jolla, California  92093-0658
City of Hope Comprehensive Cancer Center Duarte, California  91010
Kansas Masonic Cancer Research Institute at the University of Kansas Medical Center Kansas City, Kansas  66160-7353
Josephine Ford Cancer Center at Henry Ford Hospital Detroit, Michigan  48202
James Graham Brown Cancer Center at University of Louisville Louisville, Kentucky  40202
Lake/University Ireland Cancer Center Mentor, Ohio  44060
Waukesha Memorial Hospital Regional Cancer Center Waukesha, Wisconsin  53188
Winship Cancer Institute of Emory University Atlanta, Georgia  30322
Hollings Cancer Center at Medical University of South Carolina Charleston, South Carolina  29425
St. Vincent Hospital Regional Cancer Center Green Bay, Wisconsin  54307-3508
James P. Wilmot Cancer Center at University of Rochester Medical Center Rochester, New York  14642
Green Bay Oncology, Limited at St. Vincent Hospital Regional Cancer Center Green Bay, Wisconsin  54301-3526
Bay Area Cancer Care Center at Bay Area Medical Center Marinette, Wisconsin  54143
David C. Pratt Cancer Center at St. John's Mercy St. Louis, Missouri  63141
University of New Mexico Cancer Center Albuquerque, New Mexico  87131-5636
Oklahoma University Cancer Institute Oklahoma City, Oklahoma  73104
Geisinger Cancer Institute at Geisinger Health Danville, Pennsylvania  17822-0001
M. D. Anderson Cancer Center at University of Texas Houston, Texas  77030-4009
Virginia Commonwealth University Massey Cancer Center Richmond, Virginia  23298-0037
Gundersen Lutheran Center for Cancer and Blood La Crosse, Wisconsin  54601
University of Virginia Cancer Center Charlottesville, Virginia  22908
Fox Chase Cancer Center - Philadelphia Philadelphia, Pennsylvania  19111-2497
Ingalls Cancer Care Center at Ingalls Memorial Hospital Harvey, Illinois  60426
Highland Hospital of Rochester Rochester, New York  14620
North Coast Cancer Care, Incorporated Sandusky, Ohio  44870
Regional Cancer Center at Singing River Hospital Pascagoula, Mississippi  39581
Truman Medical Center - Hospital Hill Kansas City, Missouri  64108
Leo W. Jenkins Cancer Center at ECU Medical School Greenville, North Carolina  27834
Summa Center for Cancer Care at Akron City Hospital Akron, Ohio  44309-2090
Barberton Citizens Hospital Barberton, Ohio  44203
Flower Hospital Cancer Center Sylvania, Ohio  43560
McGlinn Family Regional Cancer Center at Reading Hospital and Medical Center Reading, Pennsylvania  19612-6052
York Cancer Center at Apple Hill Medical Center York, Pennsylvania  17405
Schiffler Cancer Center at Wheeling Hospital Wheeling, West Virginia  26003
Radiological Associates of Sacramento Medical Group, Incorporated Sacramento, California  95815
Regional Cancer Center at Oconomowoc Memorial Hospital Oconomowoc, Wisconsin  53066
Cancer Institute at St. John's Hospital Springfield, Illinois  62701
Sentara Cancer Institute at Sentara Norfolk General Hospital Norfolk, Virginia  23507
Veterans Affairs Medical Center - Milwaukee Milwaukee, Wisconsin  53295
Radiation Oncology Associates, PA Albuquerque, New Mexico  87109
Saint John's Cancer Center at Saint John's Medical Center Anderson, Indiana  46016
Renown Institute for Cancer at Renown Regional Medical Center Reno, Nevada  89502
Memorial Sloan-Kettering Cancer Center at Phelps Memorial Hospital Center Sleepy Hollow, New York  10591
Fox Chase Cancer Center Buckingham Furlong, Pennsylvania  18925
Saint Elizabeth Cancer Institute at Saint Elizabeth Regional Medical Center Lincoln, Nebraska  68510
Charach Cancer Center at Huron Valley - Sinai Hospital Commerce, Michigan  48382
Memorial Sloan-Kettering Cancer Center - Basking Ridge Basking Ridge, New Jersey  07920
Memorial Sloan-Kettering Cancer Center - Rockville Centre Rockville Centre, New York  11570