Phase III Trial Of Docetaxel Versus Docetaxel Plus ZD1839 In Head And Neck Cancer

Inclusion Criteria: Histologically or cytologically confirmed squamous cell carcinoma of the head and neck; patient must not have nasopharyngeal carcinoma of histologic types World Health Organization (WHO) 2 and 3 Metastatic or locally recurrent carcinoma of the head and neck that is considered incurable by local therapies Any number of prior chemotherapy or biologic/targeted therapy regimens is allowed No prior systemic EGFR inhibitors, such as ZD1839 (Iressa, gefitinib)/Iressa (AstraZeneca), ABX-EBX (Abgenix), MDX-447 (Medarex/Merck), OSI-774/Tarceva (OSI pharmaceuticals), C225/Cetuximab (ImClone), PKI166 (Novartis), CI-1033 (Parke-Davis), EKB-569 (Wyeth Ayerst); treatment with paclitaxel is allowed if the patient did not progress while on paclitaxel NOTE: the use of cetuximab given concurrently with radiation or chemoradiotherapy for up to 9 total weekly doses, as part of initial potentially curative therapy is allowed, if completed > 6 months prior to registration Patients must not receiving any other investigational agent while on the study Patients must have either: Strata A: Eastern Cooperative Oncology Group (ECOG) performance status (PS) 2 (in bed 50% of the time. Ambulatory and capable of all self-care, but unable to carry out any work activities; up and about more than 50% of waking hours), AND no prior chemotherapy for recurrent metastatic head and neck cancer OR Strata B PS 0-2 AND prior chemotherapy (i.e. one or more prior chemotherapy regimens (without docetaxel)) for locally recurrent/metastatic disease or exposure to prior chemotherapy (without docetaxel) as part of primary curative therapy < 6 months prior to randomization; patients who receive chemotherapy as part of potentially curative therapy of primary disease within 6 months of randomization will be considered as having prior chemotherapy for recurrent/metastatic disease, whereas patients who received chemotherapy as part of potentially curative therapy of disease > 6 months of randomization will be considered as having no prior chemotherapy for recurrent/metastatic disease Patients must have fully recovered from the effects of any prior surgery, chemotherapy, or radiation therapy A minimum time period of 3 weeks must elapse between the completion of radiation therapy and randomization to the study A minimum period of 4 weeks must elapse between the last administration of any prior chemotherapy and randomization to the study At least 2 weeks must elapse between the last administration of biologic/targeted therapy and randomization to the study Patients must be > 3 weeks since major surgery, or significant traumatic injury prior to randomization Absolute neutrophil count (ANC) >= 1500 /mm^3 Platelets >= 100,000 /mm^3 Hemoglobin >= 8.0 g/dl Bilirubin within normal limits Creatinine < 2.0 or creatinine clearance of > 60 ml/min All females of childbearing potential must have a blood test or urine study within 2 weeks prior to randomization to rule out pregnancy Women of childbearing potential and sexually active males must use an accepted and effective method of contraception while on treatment and for three months after the completion of treatment Patients must have measurable or non-measurable disease based on Response Evaluation Criteria In Solid Tumors (RECIST); baseline measurements and evaluations must be obtained < 4 weeks of randomization; all areas of disease should be recorded and mapped out in order to assess response and uniformity of response to therapy; disease in previously irradiated sites is considered measurable if there has been unequivocal disease progression or biopsy-proven residual carcinoma following radiation therapy; persistent disease after radiotherapy must be biopsy proven at least 8 weeks after completion of radiation therapy Radiographic findings are acceptable providing that clear-cut measurements can be made Patients with a prior history of squamous cell or basal carcinoma of the skin or in situ cervical cancer must have been curatively treated. Patients with a history of other prior malignancy must have been treated with curative intent and must have remained disease-free for 5 years post diagnosis Drugs that are Cytochrome P450 3A4 (CYP3A4) inhibitors should be generally avoided and if possible, discontinued, 1 week prior to initiating study drug; however, if medically necessary, they can be taken with caution after consulting with the study chair From patients consenting to participate in the correlative studies: Tissues must be submitted as outlined in Section 10; if tissue cannot be submitted, written justification must be submitted to the ECOG Pathology Coordinating Office Exclusion criteria: Prior therapy with docetaxel at any time (even if part of prior curative treatment) Unstable systemic disease, including active infection, uncontrolled hypertension, unstable angina, congestive heart failure, or serious arrhythmia requiring medication Hypercalcemia related to head and neck cancer Brain metastasis Current peripheral neuropathy >= grade 2 at time of randomization Patients have co-existing condition that would preclude full compliance with the study Known hypersensitivity to ZD1839 (Iressa, gefitinib) or any excipients of this product; prior history of severe hypersensitivity reaction to Docetaxel or other drugs formulated with polysorbate 80 HIV positive patient's receiving combination anti-retroviral therapy are excluded from the study because of possible pharmacokinetic interactions with ZD1839 (Iressa, gefitinib) Patients have had tumor-related hemorrhagic events in the previous three months that required as major medical intervention, such as surgery or embolization Patients are on therapeutic anticoagulation or have tumors that are unequivocally invading major vessels (e.g. carotid artery) Females are pregnant or breast feeding because chemotherapy may be harmful to the fetus or the nursing infant; also, the effects of ZD1839 (Iressa, gefitinib) on the developing human fetus are unknown