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Cediranib Maleate in Treating Patients With Recurrent or Newly Diagnosed Metastatic Head and Neck Cancer

Primary Purpose

Recurrent Hypopharyngeal Squamous Cell Carcinoma, Recurrent Laryngeal Squamous Cell Carcinoma, Recurrent Laryngeal Verrucous Carcinoma

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Cediranib Maleate
Laboratory Biomarker Analysis
Sponsored by
National Cancer Institute (NCI)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Recurrent Hypopharyngeal Squamous Cell Carcinoma

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Histologically confirmed squamous cell carcinoma of the head and neck meeting one of the following criteria:

    • Recurrent disease

      • Previously treated with standard curative therapy, including surgery and/or radiotherapy with or without chemotherapy
    • Newly diagnosed metastatic disease
  • Must be deemed incurable by all of the following:

    • Salvage surgery
    • Radiotherapy
  • Measurable disease ≥ 1 cm by conventional techniques, flexible fiberoptic laryngoscopy, or examination under anesthesia
  • No more than 2 prior conventional or investigational systemic therapies for categorically incurable local-regional or distant disease
  • No known primary brain tumor or brain metastases
  • ECOG performance status 0-1
  • Life expectancy ≥ 6 months
  • WBC > 3,000/mm³
  • Absolute neutrophil count > 1,500/mm³
  • Platelet count > 100,000/mm³
  • Hemoglobin > 8 g/dL
  • Bilirubin normal
  • AST and ALT ≤ 2.5 times upper limit of normal
  • Creatinine normal OR creatinine clearance > 60 mL/min
  • Proteinuria ≤ +1 on 2 consecutive urine dipsticks taken ≥ 1 week apart
  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective contraception
  • History of nonmelanoma skin cancer or other prior malignancy allowed provided the cancer has been in remission for > 3 years
  • No history of allergic reaction attributed to compounds of similar chemical or biological composition to AZD2171
  • No hypertension (i.e., systolic blood pressure (BP) > 160 mm Hg and diastolic BP > 100 mm Hg)
  • No history of hypertensive urgency, hypertensive emergency, or end-organ damage (i.e., thrombotic stroke, transient ischemic attacks, intracerebral hemorrhage, myocardial infarction, aortic aneurysm, or aortic dissection)
  • QTc ≤ 500 msec (with Bazett's correction)
  • No history of familial long QT syndrome
  • No concurrent uncontrolled illness including, but not limited to, any of the following:

    • Bleeding diathesis
    • Congestive heart failure, defined as New York Heart Association (NYHA) class III-IV congestive heart failure

      • NYHA class II congestive heart failure allowed provided there is increased monitoring
    • Significant ECG abnormality
    • Peripheral vascular disease
    • Unstable angina pectoris
    • Cardiac arrhythmia
    • Pulmonary edema
    • Atrioventricular (AV) conduction abnormalities
    • Sick sinus syndrome
    • Second- or third-degree AV block
    • Deep venous thrombosis
  • No nonhealing ulcers, bone fracture, or wounds
  • No psychiatric illness or social situation that would preclude study compliance
  • No traumatic injury within the past 7 days
  • No known coagulopathy that increases risk of bleeding
  • No history of clinically significant hemorrhages
  • See Disease Characteristics
  • Recovered from all prior therapies
  • No prior antiangiogenic therapy
  • No more than 2 prior chemotherapy or antineoplastic regimens for categorically incurable local-regional or distant disease
  • At least 4 weeks since prior radiotherapy or major surgery
  • At least 3 weeks since prior chemotherapy (6 weeks for nitrosoureas or mitomycin C)
  • More than 30 days since prior participation in an investigational trial
  • No other concurrent investigational agents
  • No concurrent drugs or biologics with proarrhythmic potential
  • No concurrent anticoagulants (e.g., warfarin) or antiplatelet agents
  • No concurrent combination antiretroviral therapy for HIV-positive patients
  • No other concurrent anticancer agents or therapies

Sites / Locations

  • Massachusetts General Hospital Cancer Center

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Treatment (enzyme inhibitor)

Arm Description

Patients receive oral cediranib maleate once daily on days 1-28. Treatment repeats every 28 days in the absence of disease progression or unacceptable toxicity.

Outcomes

Primary Outcome Measures

Tumor response (complete response [CR], partial response [PR], progressive disease [PD], and stable disease [SD]) as determined by the Response Evaluation Criteria in Solid Tumors (RECIST) criteria
Compared using logistic regression.

Secondary Outcome Measures

Adverse events, graded according to the revised National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 3.0
Analyzed using binomial confidence intervals for these proportions.
Distant metastasis
Analyzed with binomial confidence intervals as well as Kaplan-Meier estimates for these proportions.
Overall survival
Analyzed with binomial confidence intervals as well as Kaplan-Meier estimates for these proportions.
Progression-free survival
Analyzed with binomial confidence intervals as well as Kaplan-Meier estimates for these proportions.

Full Information

First Posted
April 9, 2007
Last Updated
April 14, 2015
Sponsor
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT00458978
Brief Title
Cediranib Maleate in Treating Patients With Recurrent or Newly Diagnosed Metastatic Head and Neck Cancer
Official Title
Phase II Clinical Trial of AZD2171 Monotherapy in Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma Patients
Study Type
Interventional

2. Study Status

Record Verification Date
April 2014
Overall Recruitment Status
Completed
Study Start Date
February 2007 (undefined)
Primary Completion Date
May 2013 (Actual)
Study Completion Date
July 2014 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
National Cancer Institute (NCI)

4. Oversight

5. Study Description

Brief Summary
This phase II trial is studying how well cediranib maleate works in treating patients with recurrent or newly diagnosed metastatic head and neck cancer. Cediranib maleate may stop the growth of head and neck cancer by blocking some of the enzymes needed for cell growth and by blocking blood flow to the tumor.
Detailed Description
PRIMARY OBJECTIVES: I. Determine the objective clinical response in patients with recurrent or newly diagnosed metastatic squamous cell carcinoma of the head and neck treated with AZD2171 (cediranib maleate). SECONDARY OBJECTIVES: I. Determine the safety profile of this drug in these patients. II. Assess the early and late physiological and biological effects of this drug on tumor interstitial fluid pressure, pO2, and tumor microvasculature. III. Assess the value of potential noninvasive biomarkers of response, including plasma levels of molecules involved in angiogenesis, circulating endothelial cells and progenitor cells, and functional imaging changes before and after treatment. IV. Assess the gene expression patterns before and after treatment as predictors of clinical and biological response. OUTLINE: This is a multicenter study. Patients receive oral cediranib maleate once daily on days 1-28. Treatment repeats every 28 days in the absence of disease progression or unacceptable toxicity. Patients undergo dynamic contrast-enhanced CT imaging and blood collection periodically during study for research studies assessing plasma levels of angiogenic/antiangiogenic molecules, circulating endothelial cells (by flow cytometry), progenitor cells, and protein analysis of potential biomarkers.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Recurrent Hypopharyngeal Squamous Cell Carcinoma, Recurrent Laryngeal Squamous Cell Carcinoma, Recurrent Laryngeal Verrucous Carcinoma, Recurrent Lip and Oral Cavity Squamous Cell Carcinoma, Recurrent Metastatic Squamous Cell Carcinoma in the Neck With Occult Primary, Recurrent Nasal Cavity and Paranasal Sinus Squamous Cell Carcinoma, Recurrent Nasopharyngeal Keratinizing Squamous Cell Carcinoma, Recurrent Oral Cavity Verrucous Carcinoma, Recurrent Oropharyngeal Squamous Cell Carcinoma, Recurrent Salivary Gland Carcinoma, Salivary Gland Squamous Cell Carcinoma, Squamous Cell Carcinoma Metastatic in the Neck With Occult Primary, Stage IV Hypopharyngeal Squamous Cell Carcinoma, Stage IV Laryngeal Squamous Cell Carcinoma, Stage IV Laryngeal Verrucous Carcinoma, Stage IV Lip and Oral Cavity Squamous Cell Carcinoma, Stage IV Major Salivary Gland Carcinoma, Stage IV Nasal Cavity and Paranasal Sinus Squamous Cell Carcinoma, Stage IV Nasopharyngeal Keratinizing Squamous Cell Carcinoma, Stage IV Oral Cavity Verrucous Carcinoma, Stage IV Oropharyngeal Squamous Cell Carcinoma, Tongue Carcinoma, Untreated Metastatic Squamous Cell Carcinoma to Neck With Occult Primary

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
6 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Treatment (enzyme inhibitor)
Arm Type
Experimental
Arm Description
Patients receive oral cediranib maleate once daily on days 1-28. Treatment repeats every 28 days in the absence of disease progression or unacceptable toxicity.
Intervention Type
Drug
Intervention Name(s)
Cediranib Maleate
Other Intervention Name(s)
AZD2171, AZD2171 Maleate, Recentin
Intervention Description
Given orally
Intervention Type
Other
Intervention Name(s)
Laboratory Biomarker Analysis
Intervention Description
Correlative studies
Primary Outcome Measure Information:
Title
Tumor response (complete response [CR], partial response [PR], progressive disease [PD], and stable disease [SD]) as determined by the Response Evaluation Criteria in Solid Tumors (RECIST) criteria
Description
Compared using logistic regression.
Time Frame
Baseline to day 29
Secondary Outcome Measure Information:
Title
Adverse events, graded according to the revised National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 3.0
Description
Analyzed using binomial confidence intervals for these proportions.
Time Frame
Up to 28 days after last dose of study treatment
Title
Distant metastasis
Description
Analyzed with binomial confidence intervals as well as Kaplan-Meier estimates for these proportions.
Time Frame
Every 2 courses until progression
Title
Overall survival
Description
Analyzed with binomial confidence intervals as well as Kaplan-Meier estimates for these proportions.
Time Frame
Up to 28 days after last dose of study treatment
Title
Progression-free survival
Description
Analyzed with binomial confidence intervals as well as Kaplan-Meier estimates for these proportions.
Time Frame
Up to 28 days after last dose of study treatment

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Histologically confirmed squamous cell carcinoma of the head and neck meeting one of the following criteria: Recurrent disease Previously treated with standard curative therapy, including surgery and/or radiotherapy with or without chemotherapy Newly diagnosed metastatic disease Must be deemed incurable by all of the following: Salvage surgery Radiotherapy Measurable disease ≥ 1 cm by conventional techniques, flexible fiberoptic laryngoscopy, or examination under anesthesia No more than 2 prior conventional or investigational systemic therapies for categorically incurable local-regional or distant disease No known primary brain tumor or brain metastases ECOG performance status 0-1 Life expectancy ≥ 6 months WBC > 3,000/mm³ Absolute neutrophil count > 1,500/mm³ Platelet count > 100,000/mm³ Hemoglobin > 8 g/dL Bilirubin normal AST and ALT ≤ 2.5 times upper limit of normal Creatinine normal OR creatinine clearance > 60 mL/min Proteinuria ≤ +1 on 2 consecutive urine dipsticks taken ≥ 1 week apart Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception History of nonmelanoma skin cancer or other prior malignancy allowed provided the cancer has been in remission for > 3 years No history of allergic reaction attributed to compounds of similar chemical or biological composition to AZD2171 No hypertension (i.e., systolic blood pressure (BP) > 160 mm Hg and diastolic BP > 100 mm Hg) No history of hypertensive urgency, hypertensive emergency, or end-organ damage (i.e., thrombotic stroke, transient ischemic attacks, intracerebral hemorrhage, myocardial infarction, aortic aneurysm, or aortic dissection) QTc ≤ 500 msec (with Bazett's correction) No history of familial long QT syndrome No concurrent uncontrolled illness including, but not limited to, any of the following: Bleeding diathesis Congestive heart failure, defined as New York Heart Association (NYHA) class III-IV congestive heart failure NYHA class II congestive heart failure allowed provided there is increased monitoring Significant ECG abnormality Peripheral vascular disease Unstable angina pectoris Cardiac arrhythmia Pulmonary edema Atrioventricular (AV) conduction abnormalities Sick sinus syndrome Second- or third-degree AV block Deep venous thrombosis No nonhealing ulcers, bone fracture, or wounds No psychiatric illness or social situation that would preclude study compliance No traumatic injury within the past 7 days No known coagulopathy that increases risk of bleeding No history of clinically significant hemorrhages See Disease Characteristics Recovered from all prior therapies No prior antiangiogenic therapy No more than 2 prior chemotherapy or antineoplastic regimens for categorically incurable local-regional or distant disease At least 4 weeks since prior radiotherapy or major surgery At least 3 weeks since prior chemotherapy (6 weeks for nitrosoureas or mitomycin C) More than 30 days since prior participation in an investigational trial No other concurrent investigational agents No concurrent drugs or biologics with proarrhythmic potential No concurrent anticoagulants (e.g., warfarin) or antiplatelet agents No concurrent combination antiretroviral therapy for HIV-positive patients No other concurrent anticancer agents or therapies
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
James Rocco
Organizational Affiliation
Massachusetts General Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Massachusetts General Hospital Cancer Center
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02114
Country
United States

12. IPD Sharing Statement

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Cediranib Maleate in Treating Patients With Recurrent or Newly Diagnosed Metastatic Head and Neck Cancer

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