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Induction Chemotherapy for Locally Advanced Squamous Cell Carcinoma of the Head and Neck

Primary Purpose

Head and Neck Cancer

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Cetuximab
Nab-paclitaxel
Carboplatin
Sponsored by
UNC Lineberger Comprehensive Cancer Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Head and Neck Cancer focused on measuring Head and neck cancer, Phase II, Locally advanced, Squamous Cell, Carboplatin, Nab-paclitaxel, Abraxane, Cetuximab, Induction, Chemotherapy

Eligibility Criteria

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

Inclusion Criteria:

  • Histologically or cytologically confirmed SCCHN or poorly differentiated or undifferentiated cancer of the head and neck.
  • Measurable disease.
  • All primary sites are eligible excluding nasopharyngeal.
  • Surgically unresectable and/or N2b or greater nodal disease; Note: surgical unresectability will be defined as the combination of the treating surgeon's judgment of unresectability plus one of the following objective criteria:

    • Encasement of tumor or nodes to the carotid artery or ¾ encasement of the carotid artery.
    • Involvement of prevertebral musculature
    • Invasion of the bone of the skull base
    • Need for glossectomy or extensive glossal resection where functional outcome is considered unacceptable to surgeon or patient
    • Involvement of the cervical spine
    • Severe, unacceptable functional deficit that would result from any proposed definitive surgical resection.
  • ECOG performance status 0-1
  • Prior therapy:

    • Chemotherapy: No prior chemotherapy for the treatment of SCCHN.
    • Platinum chemotherapy: No previous history of carboplatin or cisplatin therapy.
    • Nab-paclitaxel: No previous treatment with nab-paclitaxel or another taxane.
    • Cetuximab: No previous treatment with cetuximab Or another epidermal growth factor receptor (EGFR) inhibitor.
    • Radiation therapy: No prior radiation to the head and neck region.
  • Age > or = 18 years. Men and women are eligible for participation.
  • Must have acceptable organ and marrow function as defined below. Laboratory tests should be completed within 14 days prior to registration:

    • Absolute Neutrophil Count (ANC) > or = 1,500/mm3
    • Platelets > or = 100,000/mm3
    • Hemoglobin (Hgb) > 9g/dL
    • Total bilirubin < or = 1.5mg/dL
    • Albumin > 2.5 g/dL
    • Aspartate aminotransferase (AST)/Alanine Aminotransferase (ALT) < or = 2.5 times institutional upper limit of normal, alkaline phosphatase < 2.5 x upper limit of normal, glomerular filtration rate (GFR) > 30 mL/min (by standard Cockcroft and Gault formula or measured via 24 hour urine collection)
  • No pre-existing neuropathy greater than grade I
  • Women of childbearing potential must have a negative serum or urine pregnancy test performed within 7 days prior to day 1 of study treatment.
  • Women of childbearing potential and men must agree to use adequate contraception prior to study entry, for the duration of study participation and for three months after completing treatment. Adequate contraception is defined as any medically recommended method (or combination of methods) as per standard of care.
  • Patients must have the ability to understand and the willingness to sign a written informed consent document.
  • Patients must have a negative result for preformed immunoglobulin E (IgE) antibodies to galactose-alpha-1,3,-galactose.

Exclusion Criteria:

  • Prior treatment with any of the study medications.
  • Prior radiation to any of the field required to treat the tumor.
  • Any metastatic disease.
  • The patient may have had a prior malignancy but must be disease-free for three years prior to study entry. A history of superficial non-melanoma skin cancer or in situ carcinoma of the cervix less than three years will be allowed.
  • Pregnant or lactating female
  • Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection requiring IV antibiotics, or psychiatric illness/social situations that would limit compliance with study requirements. Cardiac disease such as symptomatic congestive heart failure, unstable angina pectoris, or myocardial infarction will result in exclusion only if active within the past six months. Cardiac dysrhythmia will only result in exclusion if active and symptomatic (for example, rate-controlled atrial fibrillation will not result in exclusion).

Sites / Locations

  • University of North Carolina at Chapel Hill
  • Vanderbilt University
  • University of Washington

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Treatment

Arm Description

nab-paclitaxel 100mg/m2 Carboplatin area under curve (AUC)2 (IV) Cetuximab 400mg/m2 week 1 then 250mg/m2 for six weeks

Outcomes

Primary Outcome Measures

Clinical Response Rate Following Induction Chemotherapy
Evaluation of target lesions via imaging with CT or MRI scans at 2-3 weeks post induction chemotherapy. Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0) for target lesions and assessed by MRI: Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), >=30% decrease in the sum of the longest diameter of target lesions.

Secondary Outcome Measures

Rate of Complete Response Following Induction Chemotherapy
Report the rate of complete responses, defined as disappearance of all target lesions, following induction chemotherapy. Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.1) for target lesions and assessed by MRI: Complete Response (CR), Disappearance of all target lesions.
Progression Free Survival
Rate of Progression Free Survival (Time to death or progression defined by imaging of target lesions via CT or MRI scan post induction chemotherapy and chemoradiotherapy every 3 months for one year)
Objective Response Rate (CR+PR)
Objective Response Rate as defined by RECIST 1.1 after induction chemotherapy followed by definitive chemoradiation. Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.1) for target lesions and assessed by MRI: Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), >=30% decrease in the sum of the longest diameter of target lesions; Objective Response (OR) = CR + PR.
Complete Response Rate (CR)
Complete Response Rate as defined by RECIST 1.1 after induction chemotherapy followed by definitive chemoradiation
Overall Survival
Rate of Overall Survival
Number of Participants With at Least One Grade 3-4 Toxicity
Toxicity will be assessed according to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 4.
Number of Participants With at Least One Grade 3-4 Toxicity, Listed by Event
Toxicity will be assessed according to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 4.
Patient-reported Quality of Life Scores
Functional Assessment of Cancer Therapy - Head & Neck (FACT-HN) is the FACT-G and a 12 item head and neck cancer specific subscale completed at screening (Screening), 3 weeks post induction chemotherapy (Treatment Break), 7 weeks post concomitant chemoradiotherapy (7 weeks Off Treatment), one year post off-treatment (1 year Off Treatment). The FACT-G is a 27 item measure of general QOL assessing function in 4 domains: physical well-being (PWB), social-family well-being (SFWB), emotional well-being (EWB) and functional well-being (FWB). Items are rated by patients on a Likert scale from 0 to 4 (resulting in potential total scores between 0 and 156). Higher scores represent better QOL.

Full Information

First Posted
August 5, 2011
Last Updated
November 3, 2020
Sponsor
UNC Lineberger Comprehensive Cancer Center
Collaborators
Celgene Corporation
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1. Study Identification

Unique Protocol Identification Number
NCT01412229
Brief Title
Induction Chemotherapy for Locally Advanced Squamous Cell Carcinoma of the Head and Neck
Official Title
A Phase II Study of Carboplatin, Nab-paclitaxel and Cetuximab for Induction Chemotherapy for Locally Advanced Squamous Cell Carcinoma of the Head and Neck
Study Type
Interventional

2. Study Status

Record Verification Date
September 2020
Overall Recruitment Status
Completed
Study Start Date
February 2012 (undefined)
Primary Completion Date
June 20, 2015 (Actual)
Study Completion Date
December 2019 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
UNC Lineberger Comprehensive Cancer Center
Collaborators
Celgene Corporation

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This is a non-randomized, open-label phase II trial of 40 patients with poor prognosis head and neck cancer, defined as surgically unresectable and/or ≥N2b disease and judged appropriate for non-surgical definitive therapy.
Detailed Description
This is a non-randomized, open-label phase II trial of 40 patients with poor prognosis head and neck cancer, defined as surgically unresectable and/or ≥N2b disease and judged appropriate for non-surgical definitive therapy. Patients must have Eastern Cooperative Oncology Group (ECOG) performance status of 0-1 with good organ function and will be treated with six weekly cycles of carboplatin, nab-paclitaxel and cetuximab prior to scheduled concomitant chemoradiation. The study is designed to evaluate whether this induction regimen can result in an improved response rate (complete response (CR) + partial response (PR)) with less toxicity than the current standard induction docetaxel, cisplatin and 5-fluorouracil (TPF) regimen.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Head and Neck Cancer
Keywords
Head and neck cancer, Phase II, Locally advanced, Squamous Cell, Carboplatin, Nab-paclitaxel, Abraxane, Cetuximab, Induction, Chemotherapy

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Treatment
Arm Type
Experimental
Arm Description
nab-paclitaxel 100mg/m2 Carboplatin area under curve (AUC)2 (IV) Cetuximab 400mg/m2 week 1 then 250mg/m2 for six weeks
Intervention Type
Drug
Intervention Name(s)
Cetuximab
Other Intervention Name(s)
Erbitux
Intervention Description
Weekly cetuximab given intravenously for 6 weeks during induction chemotherapy and continue during the 2-3 week break prior to definitive chemoradiotherapy.
Intervention Type
Drug
Intervention Name(s)
Nab-paclitaxel
Other Intervention Name(s)
Abraxane
Intervention Description
Weekly nab-paclitaxel given intravenously following cetuximab infusion for 6 weeks.
Intervention Type
Drug
Intervention Name(s)
Carboplatin
Other Intervention Name(s)
Paraplatin
Intervention Description
Weekly carboplatin given intravenously following nab-paclitaxel infusion for 6 weeks.
Primary Outcome Measure Information:
Title
Clinical Response Rate Following Induction Chemotherapy
Description
Evaluation of target lesions via imaging with CT or MRI scans at 2-3 weeks post induction chemotherapy. Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0) for target lesions and assessed by MRI: Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), >=30% decrease in the sum of the longest diameter of target lesions.
Time Frame
9 weeks
Secondary Outcome Measure Information:
Title
Rate of Complete Response Following Induction Chemotherapy
Description
Report the rate of complete responses, defined as disappearance of all target lesions, following induction chemotherapy. Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.1) for target lesions and assessed by MRI: Complete Response (CR), Disappearance of all target lesions.
Time Frame
Baseline evaluation to 3 weeks after induction chemotherapy
Title
Progression Free Survival
Description
Rate of Progression Free Survival (Time to death or progression defined by imaging of target lesions via CT or MRI scan post induction chemotherapy and chemoradiotherapy every 3 months for one year)
Time Frame
1 year
Title
Objective Response Rate (CR+PR)
Description
Objective Response Rate as defined by RECIST 1.1 after induction chemotherapy followed by definitive chemoradiation. Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.1) for target lesions and assessed by MRI: Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), >=30% decrease in the sum of the longest diameter of target lesions; Objective Response (OR) = CR + PR.
Time Frame
20 weeks
Title
Complete Response Rate (CR)
Description
Complete Response Rate as defined by RECIST 1.1 after induction chemotherapy followed by definitive chemoradiation
Time Frame
20 weeks
Title
Overall Survival
Description
Rate of Overall Survival
Time Frame
1 year
Title
Number of Participants With at Least One Grade 3-4 Toxicity
Description
Toxicity will be assessed according to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 4.
Time Frame
9 Weeks
Title
Number of Participants With at Least One Grade 3-4 Toxicity, Listed by Event
Description
Toxicity will be assessed according to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 4.
Time Frame
24 Weeks
Title
Patient-reported Quality of Life Scores
Description
Functional Assessment of Cancer Therapy - Head & Neck (FACT-HN) is the FACT-G and a 12 item head and neck cancer specific subscale completed at screening (Screening), 3 weeks post induction chemotherapy (Treatment Break), 7 weeks post concomitant chemoradiotherapy (7 weeks Off Treatment), one year post off-treatment (1 year Off Treatment). The FACT-G is a 27 item measure of general QOL assessing function in 4 domains: physical well-being (PWB), social-family well-being (SFWB), emotional well-being (EWB) and functional well-being (FWB). Items are rated by patients on a Likert scale from 0 to 4 (resulting in potential total scores between 0 and 156). Higher scores represent better QOL.
Time Frame
screening until one year after treatment

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Histologically or cytologically confirmed SCCHN or poorly differentiated or undifferentiated cancer of the head and neck. Measurable disease. All primary sites are eligible excluding nasopharyngeal. Surgically unresectable and/or N2b or greater nodal disease; Note: surgical unresectability will be defined as the combination of the treating surgeon's judgment of unresectability plus one of the following objective criteria: Encasement of tumor or nodes to the carotid artery or ¾ encasement of the carotid artery. Involvement of prevertebral musculature Invasion of the bone of the skull base Need for glossectomy or extensive glossal resection where functional outcome is considered unacceptable to surgeon or patient Involvement of the cervical spine Severe, unacceptable functional deficit that would result from any proposed definitive surgical resection. ECOG performance status 0-1 Prior therapy: Chemotherapy: No prior chemotherapy for the treatment of SCCHN. Platinum chemotherapy: No previous history of carboplatin or cisplatin therapy. Nab-paclitaxel: No previous treatment with nab-paclitaxel or another taxane. Cetuximab: No previous treatment with cetuximab Or another epidermal growth factor receptor (EGFR) inhibitor. Radiation therapy: No prior radiation to the head and neck region. Age > or = 18 years. Men and women are eligible for participation. Must have acceptable organ and marrow function as defined below. Laboratory tests should be completed within 14 days prior to registration: Absolute Neutrophil Count (ANC) > or = 1,500/mm3 Platelets > or = 100,000/mm3 Hemoglobin (Hgb) > 9g/dL Total bilirubin < or = 1.5mg/dL Albumin > 2.5 g/dL Aspartate aminotransferase (AST)/Alanine Aminotransferase (ALT) < or = 2.5 times institutional upper limit of normal, alkaline phosphatase < 2.5 x upper limit of normal, glomerular filtration rate (GFR) > 30 mL/min (by standard Cockcroft and Gault formula or measured via 24 hour urine collection) No pre-existing neuropathy greater than grade I Women of childbearing potential must have a negative serum or urine pregnancy test performed within 7 days prior to day 1 of study treatment. Women of childbearing potential and men must agree to use adequate contraception prior to study entry, for the duration of study participation and for three months after completing treatment. Adequate contraception is defined as any medically recommended method (or combination of methods) as per standard of care. Patients must have the ability to understand and the willingness to sign a written informed consent document. Patients must have a negative result for preformed immunoglobulin E (IgE) antibodies to galactose-alpha-1,3,-galactose. Exclusion Criteria: Prior treatment with any of the study medications. Prior radiation to any of the field required to treat the tumor. Any metastatic disease. The patient may have had a prior malignancy but must be disease-free for three years prior to study entry. A history of superficial non-melanoma skin cancer or in situ carcinoma of the cervix less than three years will be allowed. Pregnant or lactating female Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection requiring IV antibiotics, or psychiatric illness/social situations that would limit compliance with study requirements. Cardiac disease such as symptomatic congestive heart failure, unstable angina pectoris, or myocardial infarction will result in exclusion only if active within the past six months. Cardiac dysrhythmia will only result in exclusion if active and symptomatic (for example, rate-controlled atrial fibrillation will not result in exclusion).
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Jared Weiss, MD
Organizational Affiliation
University of North Carolina, Chapel Hill
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of North Carolina at Chapel Hill
City
Chapel Hill
State/Province
North Carolina
ZIP/Postal Code
27599
Country
United States
Facility Name
Vanderbilt University
City
Nashville
State/Province
Tennessee
ZIP/Postal Code
37232
Country
United States
Facility Name
University of Washington
City
Seattle
State/Province
Washington
ZIP/Postal Code
98194
Country
United States

12. IPD Sharing Statement

Links:
URL
http://unclineberger.org
Description
University of North Carolina Lineberger Comprehensive Cancer Center Homepage
URL
http://www.cancer.gov
Description
National Cancer Institute Homepage

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Induction Chemotherapy for Locally Advanced Squamous Cell Carcinoma of the Head and Neck

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