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Ganetespib Window of Opportunity Study in Head and Neck Cancers

Primary Purpose

Stage I Hypopharyngeal Squamous Cell Carcinoma, Stage I Laryngeal Squamous Cell Carcinoma, Stage I Oral Cavity Squamous Cell Carcinoma

Status
Terminated
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Ganetespib
Therapeutic Conventional Surgery
Laboratory Biomarker Analysis
Sponsored by
Emory University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Stage I Hypopharyngeal Squamous Cell Carcinoma

Eligibility Criteria

19 Years - 79 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Patients must have pathologically-confirmed, resectable, squamous cell carcinoma of the oral cavity, oropharynx, larynx or hypopharynx
  • Disease may be stage I, II, III or IVa (as long as it is deemed resectable by the surgical team)
  • Tumor must be surgically resectable and curable with conventional surgery
  • Eastern Cooperative Oncology Group (ECOG) performance status 0-2
  • Patients must give documented informed consent to participate in this study
  • Absolute-neutrophil count (ANC) ≥ 1500/mm³
  • Platelet count ≥ 100,000/mm³
  • Total bilirubin ≤ within upper limit of normal (ULN)
  • Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤ 2.5 x ULN
  • Creatinine ≤ 1.5 x ULN
  • Lipase levels < 1.5 x ULN
  • Amylase levels < 1.5 x ULN

Exclusion Criteria:

  • Prior therapy with a known heat shock protein 90 (HSP90) inhibitor
  • Poor venous access for study drug administration; in this case, patients would require a peripheral or central indwelling catheter for study drug administration; study drug administration via indwelling catheters is prohibited at this time unless silicone based catheters are used; anything other than catheters made from silicone are not allowed with ganetespib therapy
  • History of severe allergic or hypersensitivity reactions to excipients (e.g., polyethylene glycol [PEG] 300 and polysorbate 80)
  • Treatment with chronic immunosuppressant (e.g., cyclosporine following transplantation)
  • Uncontrolled undercurrent illness including, but not limited to, human immunodeficiency virus (HIV)-positive subjects receiving combination antiretroviral therapy, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, ventricular arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
  • Other medications, or severe acute/chronic medical or psychiatric condition, or laboratory abnormality that may increase the risk associated with study participation or study drug administration, or may interfere with the interpretation of study results, and in the judgment of the investigator would make the subject inappropriate for entry into this study
  • Documented evidence of distant metastases or brain metastases
  • Active malignancy besides head and neck squamous cell cancer (HNSCC) or primary skin basal cell carcinoma; (patients with a concomitant malignancy that has not progressed within 12 months of study entry are eligible)
  • History of documented congestive heart failure (CHF), New York Heart Association class II/III/IV, with a history of dyspnea, orthopnea or edema that requires current treatment with angiotensin converting enzyme inhibitors, angiotensin II receptor blockers, beta-blockers or diuretics; NOTE: use of these medications for the treatment of hypertension is allowed
  • Peripheral neuropathy that is grade 2 or higher
  • Pregnancy or lactation; patients of child bearing age must agree to use adequate contraception
  • Patients residing in prison
  • CARDIAC EXCLUSION CRITERIA:

    • Known serious cardiac illness or medical conditions, including but not limited to:

      • Clinically unstable cardiac disease, including unstable atrial fibrillation, symptomatic bradycardia, unstable congestive heart failure, active myocardial ischemia, or indwelling temporary pacemaker
      • Ventricular tachycardia or a supraventricular tachycardia that requires treatment with a class Ia antiarrhythmic drug (e.g., quinidine, procainamide, disopyramide) or class III antiarrhythmic drug (e.g., sotalol, amiodarone, dofetilide); use of other antiarrhythmic drugs is permitted
      • Use of medications that have been linked to the occurrence of Torsades de pointes
      • Second- or third-degree atrioventricular (AV) block unless treated with a permanent pacemaker
      • Complete left bundle branch block (LBBB)
      • History of long QT syndrome or a family member with this condition
      • Corrected QT (QTc) > 470 ms (average of triplicate electrocardiogram [ECG] recordings); a consistent method of QTc calculation must be used for each patient's QTc measurements; QTcF (Fridericia's formula) is preferred
      • Serum potassium, magnesium, or calcium levels in the following ranges:

        • Potassium < 3.4 or > 5.1 mmol/L
        • Magnesium < 1.4 or > 2.4 mg/dL
        • Calcium < 8.9 or > 10.5 mg/dL

Sites / Locations

  • Emory University Hospital Midtown
  • Emory University/Winship Cancer Institute

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Treatment (ganetespib, surgery)

Arm Description

Patients receive ganetespib IV over 1 hour twice weekly for 2 weeks in the absence of disease progression or unacceptable toxicity. Patients then undergo surgery the day after the last dose of ganetespib.

Outcomes

Primary Outcome Measures

Change in expression of biomarkers in tissue samples, assessed by immunohistochemistry (IHC)
The biomarker expression of pre-, post-treatment, and their change will be described by summary statistics along with 95% confidence interval (CI) for the estimated mean. A paired sample Wilcoxon signed rank test will be considered to test whether the mean of post-treatment expression is different from the pre-treatment expression. This analysis will be done separately by each of the three dose levels, and by pooling all dose levels together. Kruskal-Wallis test will also be carried out.
Change in biomarker expression in blood samples
The biomarker expression of pre-, post-treatment, as well as their change will be described by summary statistics along with 95% CI for the estimated mean. A paired sample Wilcoxon signed rank test will be considered to test whether the mean of post-treatment expression is different from that of the pre-treatment expression. This analysis will be done separately by each of the three dose levels, as well as by pooling all dose levels together. Kruskal-Wallis test will also be carried out.

Secondary Outcome Measures

Full Information

First Posted
January 6, 2015
Last Updated
July 22, 2016
Sponsor
Emory University
Collaborators
Synta Pharmaceuticals Corp.
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1. Study Identification

Unique Protocol Identification Number
NCT02334319
Brief Title
Ganetespib Window of Opportunity Study in Head and Neck Cancers
Official Title
A Molecularly Driven Pilot Study of Preoperative Ganetespib in Resectable Squamous Cell Carcinoma of the Head and Neck (SCCHN)
Study Type
Interventional

2. Study Status

Record Verification Date
July 2016
Overall Recruitment Status
Terminated
Why Stopped
Lack of funding
Study Start Date
December 2014 (undefined)
Primary Completion Date
February 2016 (Actual)
Study Completion Date
February 2016 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Emory University
Collaborators
Synta Pharmaceuticals Corp.

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This pilot clinical trial studies how well ganetespib works before surgery in treating patients with stage I-IVA squamous cell carcinoma of the head and neck that can be removed by surgery. Ganetespib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Studying samples of blood and tissue in the laboratory from patients receiving ganetespib may help doctors learn more about the effects of ganetespib on cells. It may also help doctors understand how well patients respond to treatment.
Detailed Description
Ganetespib is a small molecule inhibitor of HSP90 that is currently being studied in several ongoing clinical trials. Investigators have demonstrated that ganetespib sensitizes colorectal cell lines to the effects of chemo radiotherapy in vitro. Ganetespib may have an anti-tumor effect in head and neck cancer. The investigators propose this pilot study as a first step to examine the activity of ganetespib in patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN) who have a planned surgical resection. Ganetespib has not been investigated in SCCHN. This protocol is a window of opportunity trial that will be looking at whether there is a rationale for pursuing this agent in future development of clinical trials that would then focus on therapeutic interventions with or without radiotherapy. There are therefore no clinical trials currently opened using ganetespib in SCCHN and listed on ClinicalTrials.gov. It is not clear if patients who receive this drug prior to surgery will benefit from this intervention. In this study, ganetespib will be administered twice weekly (doses approximately 72 hours apart) for 2 weeks, followed by surgery the day after the last dose of the study drug. There will be 3 dose levels, 80, 100 and 150mg/m² as highest dose. These doses were chosen based on the following considerations. In a Phase 1 study (protocol 9090-01) investigating a twice-weekly ganetespib treatment schedule, doses up to 173 mg/m² were well tolerated, with manageable diarrhea and fatigue being the most common adverse events. Extensive correlative studies and pharmacokinetic (PK)/pharmacodynamic (PD) modeling of preclinical data suggest that in humans the effective dose range for ganetespib is 70-150 mg/m². Therefore, 80 mg/m² is within the range of ganetespib effectiveness and 150 mg/m² twice weekly is a well-tolerated dose.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Stage I Hypopharyngeal Squamous Cell Carcinoma, Stage I Laryngeal Squamous Cell Carcinoma, Stage I Oral Cavity Squamous Cell Carcinoma, Stage I Oropharyngeal Squamous Cell Carcinoma, Stage II Hypopharyngeal Squamous Cell Carcinoma, Stage II Laryngeal Squamous Cell Carcinoma, Stage II Oral Cavity Squamous Cell Carcinoma, Stage II Oropharyngeal Squamous Cell Carcinoma, Stage III Hypopharyngeal Squamous Cell Carcinoma, Stage III Laryngeal Squamous Cell Carcinoma, Stage III Oral Cavity Squamous Cell Carcinoma, Stage III Oropharyngeal Squamous Cell Carcinoma, Stage IVA Hypopharyngeal Squamous Cell Carcinoma, Stage IVA Laryngeal Squamous Cell Carcinoma, Stage IVA Oral Cavity Squamous Cell Carcinoma, Stage IVA Oropharyngeal Squamous Cell Carcinoma

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
3 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Treatment (ganetespib, surgery)
Arm Type
Experimental
Arm Description
Patients receive ganetespib IV over 1 hour twice weekly for 2 weeks in the absence of disease progression or unacceptable toxicity. Patients then undergo surgery the day after the last dose of ganetespib.
Intervention Type
Drug
Intervention Name(s)
Ganetespib
Other Intervention Name(s)
Hsp90 Inhibitor STA-9090, STA-9090
Intervention Description
Given IV
Intervention Type
Procedure
Intervention Name(s)
Therapeutic Conventional Surgery
Intervention Description
Undergo surgery
Intervention Type
Other
Intervention Name(s)
Laboratory Biomarker Analysis
Intervention Description
Correlative studies
Primary Outcome Measure Information:
Title
Change in expression of biomarkers in tissue samples, assessed by immunohistochemistry (IHC)
Description
The biomarker expression of pre-, post-treatment, and their change will be described by summary statistics along with 95% confidence interval (CI) for the estimated mean. A paired sample Wilcoxon signed rank test will be considered to test whether the mean of post-treatment expression is different from the pre-treatment expression. This analysis will be done separately by each of the three dose levels, and by pooling all dose levels together. Kruskal-Wallis test will also be carried out.
Time Frame
Baseline to up to 24 months
Title
Change in biomarker expression in blood samples
Description
The biomarker expression of pre-, post-treatment, as well as their change will be described by summary statistics along with 95% CI for the estimated mean. A paired sample Wilcoxon signed rank test will be considered to test whether the mean of post-treatment expression is different from that of the pre-treatment expression. This analysis will be done separately by each of the three dose levels, as well as by pooling all dose levels together. Kruskal-Wallis test will also be carried out.
Time Frame
Baseline to up to 24 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
19 Years
Maximum Age & Unit of Time
79 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients must have pathologically-confirmed, resectable, squamous cell carcinoma of the oral cavity, oropharynx, larynx or hypopharynx Disease may be stage I, II, III or IVa (as long as it is deemed resectable by the surgical team) Tumor must be surgically resectable and curable with conventional surgery Eastern Cooperative Oncology Group (ECOG) performance status 0-2 Patients must give documented informed consent to participate in this study Absolute-neutrophil count (ANC) ≥ 1500/mm³ Platelet count ≥ 100,000/mm³ Total bilirubin ≤ within upper limit of normal (ULN) Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤ 2.5 x ULN Creatinine ≤ 1.5 x ULN Lipase levels < 1.5 x ULN Amylase levels < 1.5 x ULN Exclusion Criteria: Prior therapy with a known heat shock protein 90 (HSP90) inhibitor Poor venous access for study drug administration; in this case, patients would require a peripheral or central indwelling catheter for study drug administration; study drug administration via indwelling catheters is prohibited at this time unless silicone based catheters are used; anything other than catheters made from silicone are not allowed with ganetespib therapy History of severe allergic or hypersensitivity reactions to excipients (e.g., polyethylene glycol [PEG] 300 and polysorbate 80) Treatment with chronic immunosuppressant (e.g., cyclosporine following transplantation) Uncontrolled undercurrent illness including, but not limited to, human immunodeficiency virus (HIV)-positive subjects receiving combination antiretroviral therapy, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, ventricular arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements Other medications, or severe acute/chronic medical or psychiatric condition, or laboratory abnormality that may increase the risk associated with study participation or study drug administration, or may interfere with the interpretation of study results, and in the judgment of the investigator would make the subject inappropriate for entry into this study Documented evidence of distant metastases or brain metastases Active malignancy besides head and neck squamous cell cancer (HNSCC) or primary skin basal cell carcinoma; (patients with a concomitant malignancy that has not progressed within 12 months of study entry are eligible) History of documented congestive heart failure (CHF), New York Heart Association class II/III/IV, with a history of dyspnea, orthopnea or edema that requires current treatment with angiotensin converting enzyme inhibitors, angiotensin II receptor blockers, beta-blockers or diuretics; NOTE: use of these medications for the treatment of hypertension is allowed Peripheral neuropathy that is grade 2 or higher Pregnancy or lactation; patients of child bearing age must agree to use adequate contraception Patients residing in prison CARDIAC EXCLUSION CRITERIA: Known serious cardiac illness or medical conditions, including but not limited to: Clinically unstable cardiac disease, including unstable atrial fibrillation, symptomatic bradycardia, unstable congestive heart failure, active myocardial ischemia, or indwelling temporary pacemaker Ventricular tachycardia or a supraventricular tachycardia that requires treatment with a class Ia antiarrhythmic drug (e.g., quinidine, procainamide, disopyramide) or class III antiarrhythmic drug (e.g., sotalol, amiodarone, dofetilide); use of other antiarrhythmic drugs is permitted Use of medications that have been linked to the occurrence of Torsades de pointes Second- or third-degree atrioventricular (AV) block unless treated with a permanent pacemaker Complete left bundle branch block (LBBB) History of long QT syndrome or a family member with this condition Corrected QT (QTc) > 470 ms (average of triplicate electrocardiogram [ECG] recordings); a consistent method of QTc calculation must be used for each patient's QTc measurements; QTcF (Fridericia's formula) is preferred Serum potassium, magnesium, or calcium levels in the following ranges: Potassium < 3.4 or > 5.1 mmol/L Magnesium < 1.4 or > 2.4 mg/dL Calcium < 8.9 or > 10.5 mg/dL
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Nabil F. Saba, MD
Organizational Affiliation
Emory University/Winship Cancer Institute
Official's Role
Principal Investigator
Facility Information:
Facility Name
Emory University Hospital Midtown
City
Atlanta
State/Province
Georgia
ZIP/Postal Code
30308
Country
United States
Facility Name
Emory University/Winship Cancer Institute
City
Atlanta
State/Province
Georgia
ZIP/Postal Code
30322
Country
United States

12. IPD Sharing Statement

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Ganetespib Window of Opportunity Study in Head and Neck Cancers

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