Phase I/II Dose Escalation Trial of Induction and Concomitant Erlotinib and Celecoxib With Radiation Therapy for Treatment of Poor Prognosis Head and Neck Cancer, Including Reirradiation
Despite advances in the treatment of head and neck cancer, locoregional recurrences are the
predominant site of treatment failure and are frequently the cause of death. Second primary
tumors in the head and neck occur in up to 30% of patients at 10 years of follow-up after
eradication of the original tumor due to field cancerization. The standard approach to
patients with recurrent but non-metastatic disease has been surgical salvage alone.
Unfortunately, this strategy is feasible in only a select group of patients and 5 year
survival rates have ranged from 15-40%.
Most patients with previously irradiated unresectable recurrent or metastatic head and neck
cancer are treated with chemotherapy alone. This approach has offered limited palliation
with response rates of 10-40%, median survival of 5 to 10 months. While this may be an
acceptable option for patients with clearly incurable widespread metastatic disease, it may
not be the best approach for those patients with potentially curable locoregional disease.
While geographic misses and second primary tumors occur, the majority of patients have
radioresistant tumors. Therefore, reirradiation alone is unlikely to be effective. High dose
reirradiation with concomitant chemotherapy represents a more aggressive approach resulted
in encouraging 3-year survival rates of 15 to 35%. This approach represents a potentially
curative option for patients with unresectable or partially resected disease arising in a
previously irradiated volume. However, the high rates of acute and late toxicity with this
approach have limited widespread application of this approach.
Extensive preclinical and clinical data suggest that both epidermal growth factor receptor
(EGFR) antagonists and cycloxygenase-2 (COX-2) inhibitors enhance the effectiveness of
ionizing radiation. In locally advanced head and neck cancer, a recent phase III trial
concurrent anti-EGFR monoclonal antibody and radiation demonstrated improved local control,
disease free survival and overall survival compared to radiation alone without the increased
mucosal toxicity associated with concurrent chemotherapy. COX-2 inhibition and anti-EGFR
therapy demonstrates activity against recurrent/metastatic head and neck cancer in a recent
phase I study. Head and neck cancer represents an ideal site to study biologic markers of
tumor response because of the accessibility of tumors for biopsy. Therefore, we propose the
combination of Erlotinib and Celecoxib with radiation in a cohort of previously irradiation
patients with head and neck cancer.
Allocation: Non-Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment
Johnny Kao, M.D.
Mount Sinai School of Medicine
United States: Institutional Review Board
GCO # 06-0509
|Mount Sinai School of Medicine||New York, New York 10029|