Phase II Trial of HM781-36B in Patients With Metastatic/Recurrent Head and Neck Squamous Cell Carcinoma (HNSCC) After Failure of or Unfit for Platinum-containing Therapy
Primary Purpose
HNSCC
Status
Unknown status
Phase
Phase 2
Locations
Korea, Republic of
Study Type
Interventional
Intervention
HM781-36B
Sponsored by
About this trial
This is an interventional treatment trial for HNSCC
Eligibility Criteria
Inclusion Criteria:
- Histologically confirmed squamous cell carcinoma of head and neck
- Age ≥ 20 years
ECOG PS 0-1
- Documented progressive disease after platinum-based (either cisplatin or carboplatin) concurrent chemoradiation including induction chemotherapy for curative aim or
- Documented progressive disease after platinum-based (either cisplatin or carboplatin) chemotherapy for palliative aim or
- Ineligible to platinum-based (either cisplatin or carboplatin) chemotherapy or chemoradiation due to decline in renal function and patient's intolerance
- At least one bidimensionally measurable disease as defined by RECIST ver 1.1
Adequate organ function for treatment
- Absolute neutrophil count (ANC) ≥ 1000cells/mm3
- Platelets ≥ 100000 cells/mm3
- Estimated creatinine clearance ≥ 50mL/min, or serum creatinine < 1.5 x institution upper limit of normal
- Bilirubin ≤ 1.5 x upper limit of normal(ULN)
- AST(SGOT) ≤ 2.5 x ULN (5.0xULN if hepatic metastases)
- ALT(SGPT) ≤ 2.5 x ULN (5.0xULN if hepatic metastases)
- The patient has provided signed informed consent and is amenable to compliance with protocol schedules and testing
Exclusion Criteria:
- Nasopharyngeal carcinoma
- Patients who are subjected to local treatment (surgery or radiation)
- Previous treatment with small molecule EGFR tyrosine kinase inhibitors (Cetuximab is permitted)
- Three or more previous systemic cytotoxic chemotherapy
- Any major operation or irradiation within 4 weeks of baseline disease assessment
- Patients who have received prior systemic chemotherapy, immunotherapy or study drug within 4 weeks
- Any clinically significant gastrointestinal abnormalities which may impair intake or absorption of the study drug
- Patients with uncontrolled CNS metastatic involvement. However, patients with metastatic CNS tumors may participate in this study if the patient is clinically stable not receiving steroid therapy more than 1 week from prior therapy completion (including radiation and/or surgery) to stating the study drug.
- Patients with known interstitial lung disease (ILD) or presented ILD on screening chest X-ray
- Congenital long QT syndrome or screening corrected QT interval (QTc) > 470msec
- Patients with uncontrolled or significant cardiovascular disease (AMI within 12 months, Unstable angina within 6 months, NYHA Class III, IV Congestive heart failure or left ventricular ejection fraction below local institutional lower limit of normal or below 45%, Congenital long QT syndrome, Any significant ventricular arrhythmia, Any uncontrolled second or third degree heart block, Uncontrolled hypertension)
- Previous or concurrent malignancy except for basal or squamous cell skin cancer and/or in situ carcinoma of the cervix, or other solid tumors treated curatively and without evidence of recurrence for at least 3 years prior to study entry.
- Pregnant or breast-feeding women
- Other severe acute or chronic medical condition or laboratory abnormality that may increase the risk associated with trial participation or investigational product administration or may interfere with the interpretation of trial results and, in the judgment of the investigator, would make the patient inappropriate for entry into this trial.
Sites / Locations
- Yonsei UniversityRecruiting
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
HM781-36B
Arm Description
Outcomes
Primary Outcome Measures
Response rate
Objective Tumor Response will be performed according to the Response Evaluation in Solid Tumor Criteria 1.1 (RECIST 1.1)
Secondary Outcome Measures
Best Overall Response
Duration of response
Progression-Free Survival
Overall Survival
Toxicity profile
Overall safety profile and toleration of HM781-36B will be characterized by type, frequency, severity (as graded by the NCI CTCAE v4.02), timing and relationship of study therapy of adverse events and laboratory abnormalities. Quantitative variables will be summarized in descriptive terms.
Quality of Life (QoL)
Questionnaire
Identification of predictive markers of treatment
To explore KRAS and HER family mutation status in tissue at the end of treatment;
To explore the pre- and post-treatment levels of shed proteins/receptors related to HER signaling (possibly to include EGFR and HER-2 receptor extracellular domain (ECD) and E-cadherin);
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT02216916
Brief Title
Phase II Trial of HM781-36B in Patients With Metastatic/Recurrent Head and Neck Squamous Cell Carcinoma (HNSCC) After Failure of or Unfit for Platinum-containing Therapy
Study Type
Interventional
2. Study Status
Record Verification Date
March 2019
Overall Recruitment Status
Unknown status
Study Start Date
August 2014 (undefined)
Primary Completion Date
July 2019 (Anticipated)
Study Completion Date
July 2019 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Yonsei University
4. Oversight
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
Head and neck cancer is the sixth most common cancer and more than 650,000 new cases are diagnosed each year worldwide. About 60% of the HNSCC patients present with unresectable locally advanced disease at diagnosis and treated with multimodality approach. Despite such approach, majority (70%) of patients develop local or/and regional recurrences. Additional 10% of patients present with distant metastasis at diagnosis. Most patients with recurrent or metastatic disease are treated with single agent chemotherapy, combination chemotherapy or targeted therapies.
Despite its public health magnitude, HNSCC in Asian countries has received a limited attention for the drug development and cancer-related research. In fact, HNSCC ranked 7th among men and 10th among women by incidence in China, the largest producer and consumer of tobacco and alcohol. Recently, Chen et al. documented a 1:1:2 subset distribution for cancers of oral cavity, pharynx, and larynx in China, similar to the distribution reported in Korea but quite different from the general distribution of 5:2:3 in whites. Ethnic disparities in HNSCC also include its prognosis and this is partly explained by HPV-active disease ratio and genetic factors. Therefore, there is a strong need for an additional research in patients with HNSCC in Asia.
Epidermal growth factor receptor (EGFR) is often over-expressed, and have been related to poor prognosis in patients with HNSCC. The association between EGFR-activated signaling pathways and tumor cell survival are well documented in many studies. EGFR targeting strategies showed clinical anti-tumor efficacy in patients with HNSCC, especially with monoclonal antibody, cetuximab. In the Extreme study, it was shown that the addition of cetuximab to platinum-5-FU significantly prolonged the median overall survival from 7.4 months to 10.1 months compared to platinum-5FU alone in the first-line setting.
HM781-36B is a irreversible pan-HER inhibitor. In preclinical studies, HM781-36B has much lower IC50 values than gefitinib in cell lines engineered to express EGFRvIII mutations and produces tumor growth inhibition in gefitinib-resistant xenografts. A phase I trial of HM781-36B in patients with advanced solid tumors showed clinically significant anti-tumor activity and a phase II trials of HM781-36B in patients with non-small cell lung cancer and advanced gastric cancer are currently ongoing.
We suggest a phase II trial of HM781-36B in patients with recurrent or metastatic HNSCC who are resistant or ineligible/intolerant to platinum-based chemotherapy. The aim of current trial is to evaluate the antitumor efficacy and safety profile of HM781-36B and to identify biomarker to predict the tumor response to HM781-36B.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
HNSCC
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
49 (Anticipated)
8. Arms, Groups, and Interventions
Arm Title
HM781-36B
Arm Type
Experimental
Intervention Type
Drug
Intervention Name(s)
HM781-36B
Other Intervention Name(s)
45 mg p.o. daily and continuously (28-day treatment as one treatment cycle)
Primary Outcome Measure Information:
Title
Response rate
Description
Objective Tumor Response will be performed according to the Response Evaluation in Solid Tumor Criteria 1.1 (RECIST 1.1)
Time Frame
28th day of 1st chemotherapy cycle
Secondary Outcome Measure Information:
Title
Best Overall Response
Time Frame
1years
Title
Duration of response
Time Frame
1years
Title
Progression-Free Survival
Time Frame
1years
Title
Overall Survival
Time Frame
1years
Title
Toxicity profile
Description
Overall safety profile and toleration of HM781-36B will be characterized by type, frequency, severity (as graded by the NCI CTCAE v4.02), timing and relationship of study therapy of adverse events and laboratory abnormalities. Quantitative variables will be summarized in descriptive terms.
Time Frame
1years
Title
Quality of Life (QoL)
Description
Questionnaire
Time Frame
1years
Title
Identification of predictive markers of treatment
Description
To explore KRAS and HER family mutation status in tissue at the end of treatment;
To explore the pre- and post-treatment levels of shed proteins/receptors related to HER signaling (possibly to include EGFR and HER-2 receptor extracellular domain (ECD) and E-cadherin);
Time Frame
1years
10. Eligibility
Sex
All
Minimum Age & Unit of Time
20 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Histologically confirmed squamous cell carcinoma of head and neck
Age ≥ 20 years
ECOG PS 0-1
Documented progressive disease after platinum-based (either cisplatin or carboplatin) concurrent chemoradiation including induction chemotherapy for curative aim or
Documented progressive disease after platinum-based (either cisplatin or carboplatin) chemotherapy for palliative aim or
Ineligible to platinum-based (either cisplatin or carboplatin) chemotherapy or chemoradiation due to decline in renal function and patient's intolerance
At least one bidimensionally measurable disease as defined by RECIST ver 1.1
Adequate organ function for treatment
Absolute neutrophil count (ANC) ≥ 1000cells/mm3
Platelets ≥ 100000 cells/mm3
Estimated creatinine clearance ≥ 50mL/min, or serum creatinine < 1.5 x institution upper limit of normal
Bilirubin ≤ 1.5 x upper limit of normal(ULN)
AST(SGOT) ≤ 2.5 x ULN (5.0xULN if hepatic metastases)
ALT(SGPT) ≤ 2.5 x ULN (5.0xULN if hepatic metastases)
The patient has provided signed informed consent and is amenable to compliance with protocol schedules and testing
Exclusion Criteria:
Nasopharyngeal carcinoma
Patients who are subjected to local treatment (surgery or radiation)
Previous treatment with small molecule EGFR tyrosine kinase inhibitors (Cetuximab is permitted)
Three or more previous systemic cytotoxic chemotherapy
Any major operation or irradiation within 4 weeks of baseline disease assessment
Patients who have received prior systemic chemotherapy, immunotherapy or study drug within 4 weeks
Any clinically significant gastrointestinal abnormalities which may impair intake or absorption of the study drug
Patients with uncontrolled CNS metastatic involvement. However, patients with metastatic CNS tumors may participate in this study if the patient is clinically stable not receiving steroid therapy more than 1 week from prior therapy completion (including radiation and/or surgery) to stating the study drug.
Patients with known interstitial lung disease (ILD) or presented ILD on screening chest X-ray
Congenital long QT syndrome or screening corrected QT interval (QTc) > 470msec
Patients with uncontrolled or significant cardiovascular disease (AMI within 12 months, Unstable angina within 6 months, NYHA Class III, IV Congestive heart failure or left ventricular ejection fraction below local institutional lower limit of normal or below 45%, Congenital long QT syndrome, Any significant ventricular arrhythmia, Any uncontrolled second or third degree heart block, Uncontrolled hypertension)
Previous or concurrent malignancy except for basal or squamous cell skin cancer and/or in situ carcinoma of the cervix, or other solid tumors treated curatively and without evidence of recurrence for at least 3 years prior to study entry.
Pregnant or breast-feeding women
Other severe acute or chronic medical condition or laboratory abnormality that may increase the risk associated with trial participation or investigational product administration or may interfere with the interpretation of trial results and, in the judgment of the investigator, would make the patient inappropriate for entry into this trial.
Facility Information:
Facility Name
Yonsei University
City
Seoul
Country
Korea, Republic of
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Cho Byung Chul
Phone
82-10-5212-8867
Ext
84320
Email
cbc1971@yuhs.ac
12. IPD Sharing Statement
Citations:
PubMed Identifier
34528763
Citation
Lee JH, Heo SG, Ahn BC, Hong MH, Cho BC, Lim SM, Kim HR. A phase II study of poziotinib in patients with recurrent and/or metastatic head and neck squamous cell carcinoma. Cancer Med. 2021 Oct;10(20):7012-7020. doi: 10.1002/cam4.4231. Epub 2021 Sep 16.
Results Reference
derived
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Phase II Trial of HM781-36B in Patients With Metastatic/Recurrent Head and Neck Squamous Cell Carcinoma (HNSCC) After Failure of or Unfit for Platinum-containing Therapy
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