- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT00906360
Sunitinib, Cetuximab, and Radiation Therapy in Treating Patients With Locally Advanced or Recurrent Squamous Cell Carcinoma of the Head and Neck
A Phase I Trial of Concurrent Chemoradiation/Chemoreirradiation With Cetuximab (ERBITUX®), Sunitinib, and Accelerated Radiation in Patients With Locally Advanced/High-risk/Recurrent Poor Prognosis Head and Neck Cancer
Study Overview
Status
Conditions
- Tongue Cancer
- Recurrent Metastatic Squamous Neck Cancer With Occult Primary
- Recurrent Salivary Gland Cancer
- Recurrent Squamous Cell Carcinoma of the Hypopharynx
- Recurrent Squamous Cell Carcinoma of the Larynx
- Recurrent Squamous Cell Carcinoma of the Lip and Oral Cavity
- Recurrent Squamous Cell Carcinoma of the Oropharynx
- Recurrent Squamous Cell Carcinoma of the Paranasal Sinus and Nasal Cavity
- Recurrent Verrucous Carcinoma of the Larynx
- Recurrent Verrucous Carcinoma of the Oral Cavity
- Salivary Gland Squamous Cell Carcinoma
- Recurrent Squamous Cell Carcinoma of the Nasopharynx
- Stage III Salivary Gland Cancer
- Stage III Squamous Cell Carcinoma of the Hypopharynx
- Stage III Squamous Cell Carcinoma of the Larynx
- Stage III Squamous Cell Carcinoma of the Lip and Oral Cavity
- Stage III Squamous Cell Carcinoma of the Nasopharynx
- Stage III Squamous Cell Carcinoma of the Oropharynx
- Stage III Verrucous Carcinoma of the Larynx
- Stage III Verrucous Carcinoma of the Oral Cavity
- Stage IV Salivary Gland Cancer
- Stage IV Squamous Cell Carcinoma of the Hypopharynx
- Stage IV Squamous Cell Carcinoma of the Larynx
- Stage IV Squamous Cell Carcinoma of the Lip and Oral Cavity
- Stage IV Squamous Cell Carcinoma of the Nasopharynx
- Stage IV Squamous Cell Carcinoma of the Oropharynx
- Stage IV Verrucous Carcinoma of the Larynx
- Stage IV Verrucous Carcinoma of the Oral Cavity
- Metastatic Squamous Neck Cancer With Occult Primary Squamous Cell Carcinoma
- Untreated Metastatic Squamous Neck Cancer With Occult Primary
- Stage IV Squamous Cell Carcinoma of the Paranasal Sinus and Nasal Cavity
- Stage III Squamous Cell Carcinoma of the Paranasal Sinus and Nasal Cavity
Detailed Description
PRIMARY OBJECTIVES:
I. To assess the safety, the maximum tolerated dose, and the dose limiting toxicity of sunitinib malate when administered in combination with cetuximab and radiotherapy in patients with locally advanced, recurrent, or second primary poor prognosis, high-risk squamous cell carcinoma of the head and neck.
SECONDARY OBJECTIVES:
I. To describe the toxicity profile of this regimen. II. To explore the tolerability and feasibility of sunitinib malate when administered in combination with cetuximab and radiotherapy in these patients.
III. To assess the best overall response rate (complete and partial response) after completion of treatment.
IV. To assess the locoregional control rate. V. To assess the distant control rate. VI. To assess the pharmacokinetics of sunitinib malate delivered by percutaneous gastrostomy tube.
OUTLINE: This is a dose-escalation study of sunitinib malate.
Patients receive sunitinib malate orally or by percutaneous gastrostomy tube once daily, cetuximab IV over 60-120 minutes once weekly, and undergo concurrent radiotherapy once or twice daily, 5 days a week, for 7-9 weeks in the absence of disease progression or unacceptable toxicity. Patients with persistent disease undergo surgical resection.
*NOTE: *Patients may have resection prior to enrollment on protocol provided they have high-risk features for recurrence.
Some patients undergo blood sample collection at baseline and periodically during study for pharmacokinetic analysis of sunitinib malate and metabolites.
After completion of study treatment, patients are followed up periodically for up to 6 years.
Study Type
Enrollment (Actual)
Phase
- Phase 1
Contacts and Locations
Study Locations
-
-
Illinois
-
Chicago, Illinois, United States, 60637-1470
- University of Chicago Comprehensive Cancer Center
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Decatur, Illinois, United States, 62526
- Decatur Memorial Hospital
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Evanston, Illinois, United States, 60201
- Evanston CCOP-NorthShore University HealthSystem
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Harvey, Illinois, United States, 60426
- Ingalls Memorial Hospital
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Maywood, Illinois, United States, 60153
- Loyola University Medical Center
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Peoria, Illinois, United States, 61615
- Illinois CancerCare-Peoria
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Springfield, Illinois, United States, 60702
- Central Illinois Hematology Oncology Center
-
-
Indiana
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Fort Wayne, Indiana, United States, 46845
- Fort Wayne Medical Oncology and Hematology Inc - State Boulevard
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Maryland
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Baltimore, Maryland, United States, 21201-1595
- University of Maryland Greenebaum Cancer Center
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Michigan
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Ann Arbor, Michigan, United States, 48109
- University of Michigan University Hospital
-
-
Missouri
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Saint Louis, Missouri, United States, 63141
- Saint John's Mercy Medical Center
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Wisconsin
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Milwaukee, Wisconsin, United States, 53226
- Froedtert and The Medical College of Wisconsin
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-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
Histologically or cytologically confirmed squamous cell carcinoma of the head and neck, meeting any of the following criteria:
- Recurrent disease
- Second primary locoregional recurrence* with no clinically measurable distant disease
- Poor prognosis non-metastatic head and neck carcinoma (M0)
- Must have undergone radiotherapy as a component of prior treatment
Not a candidate for surgical resection with curative intent
- Patients with high-risk features at resection or following resection for recurrence are eligible
Must have locoregional tumor amenable to radiotherapy or reirradiation with curative intent
- Entire gross tumor recurrence volume must be able to be treated without exceeding a cumulative spinal cord dose of 50 Gy
- Unresected tumors must be measurable according to RECIST
- No known brain metastases
- ECOG performance status (PS) 0-2 OR Karnofsky PS 60-100%
- Life expectancy > 12 weeks
- WBC ≥ 3,000/mm^³
- ANC > 1,500/mm³
- Platelet count > 100,000/mm³
- Total bilirubin < 1.5 times upper limit of normal (ULN)
- INR and PTT ratio < 1.5
- AST and ALT ≤ 2.5 times ULN
- Creatinine normal OR creatinine clearance > 60 mL/min
- Urine protein no more than trace
- Hematocrit ≥ 28%
- Hemoglobin ≥ 9 g/dL
- QTc < 500 msec
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception
The following patients are eligible provided they have New York Heart Association class II cardiac function on baseline ECHO and MUGA:
- Asymptomatic on treatment
- Prior anthracycline exposure
- Prior central thoracic radiotherapy included the heart in the radiotherapy port
No clinical evidence of active infection of any type, including hepatitis B or C virus
- Infections controlled with therapy are allowed
- Patients with hepatitis B or C on antiviral therapy with no detectable virus are allowed
- No immune deficiency and/or HIV positivity
- No history of allergic reactions attributed to compounds of similar chemical or biological composition to sunitinib malate
No gastrointestinal tract disease or condition, including any of the following, that impairs ability to retain sunitinib tablets:
- Inability to take oral medication or a requirement for IV alimentation
- Prior surgical procedures affecting absorption
- Active peptic ulcer disease
None of the following conditions allowed:
- Serious or nonhealing wound, ulcer, or bone fracture
- Abdominal fistula, gastrointestinal perforation, or intra-abdominal abscess within the past 28 days
- No significant concurrent medical or psychiatric illness which, in the opinion of the investigator, would interfere with the patient's ability to participate in the trial
- No active carotid artery involvement
- No history of documented thrombosis (pulmonary embolism within the past 12 months or deep vein thrombosis [DVT] within the past 6 months), known coagulopathies or thrombophilia, or evidence of DVT/thromboembolic event
No history of the following cardiovascular conditions :
- Myocardial infarction within the past 12 months
- Cardiac arrhythmia or serious ventricular arrhythmia (ventricular fibrillation or ventricular tachycardia ≥ 3 beats in a row) within the past 12 months
- Stable/unstable angina within the past 12 months
- Symptomatic congestive heart failure within the past 12 months
- Coronary/peripheral artery bypass graft or stenting within the past 12 months
- No cerebral vascular disease, cerebrovascular accident (stroke), or transient ischemic attack within the past 6 months
- QTc prolongation (QTc interval ≥ 500 msec)
- New York Heart Association class III-IV congestive heart failure
- Poorly controlled hypertension (i.e., systolic blood pressure [BP] ≥ 140 mm Hg or diastolic BP ≥ 90 mm Hg)
- Other significant ECG abnormalities
- See Disease Characteristics
- Recovered from all prior radiotherapy and chemotherapy
- More than 4 months since prior radiotherapy to the head and neck
- More than 2 weeks since prior hormone replacement therapy or hormonal contraceptives
- More than 4 weeks since prior and no other concurrent investigational agents
- At least 1 month since prior surgery (unless ambulatory within 48 hours)
At least 7 days since prior and no concurrent CYP3A4 inhibitors, including any of the following:
- Azole antifungals (ketoconazole, itraconazole)
- Clarithromycin
- Erythromycin
- Diltiazem
- Verapamil
- HIV protease inhibitors (indinavir, saquinavir, ritonavir, atazanavir, nelfinavir)
- Delavirdine
At least 12 days since prior and no concurrent CYP3A4 inducers, including any of the following:
- Rifampin
- Rifabutin
- Carbamazepine
- Phenobarbital
- Phenytoin
- St. John wort
- Efavirenz
- Tipranavir
- Concurrent coumarin-derivative anticoagulants (e.g., warfarin up to 2 mg daily) allowed for prophylaxis of thrombosis
- Concurrent use of medications known to affect the conductive system (e.g., beta-blockers, calcium channel blockers, or digoxin) allowed under investigator supervision
No concurrent agent with proarrhythmic potential, including any of the following:
- Terfenadine
- Quinidine
- Procainamide
- Disopyramide
- Sotalol
- Probucol
- Bepridil
- Haloperidol
- Risperidone
- Indapamide
- Flecainide
- No concurrent chronic steroid treatment for > 6 months (i.e., prednisolone doses > 10 mg/day or equivalent)
- No concurrent combination antiretroviral therapy for HIV-positive patients
- No concurrent amifostine
- No concurrent commercial agent or therapy intended to treat head and neck cancer
- No other concurrent anticancer therapy
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Treatment (enzyme inhibitor and monoclonal antibody therapy)
Patients receive sunitinib malate orally or by percutaneous gastrostomy tube once daily, cetuximab IV over 60-120 minutes once weekly, and undergo concurrent radiotherapy once or twice daily, 5 days a week, for 7-9 weeks in the absence of disease progression or unacceptable toxicity.
Patients with persistent disease undergo surgical resection.
|
Correlative studies
Other Names:
Given IV
Other Names:
Undergo radiotherapy
Other Names:
Given orally or by percutaneous gastrostomy tube
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Maximum-tolerated dose (MTD) of sunitinib malate
Time Frame: Up to 7-9 weeks
|
MTD is defined as the dose level immediately below the non-tolerated dose.
The study will utilize a standard "3+3" design to determine the MTD.
Dose limiting toxicities (DLTs) used for determining escalation of dose will be those occurring within the period of radiotherapy.
Toxicity will be summarized by type and severity using the National Cancer Institute (NCI) Common Terminology Criteria.
|
Up to 7-9 weeks
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Objective tumor response rates
Time Frame: From the start of the treatment to up to 6 years
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Response will be evaluated in this study using the new international criteria proposed by the Response Evaluation Criteria in Solid Tumors (RECIST) Committee.
The efficacy analysis population (an exploratory analysis of those patients on study for the MTD) will consist of all subjects who received at least 1 dose of sunitinib.
Ninety percent confidence intervals using the exact binomial distribution will be presented.
Kaplan-Meier product limit curves will be calculated.
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From the start of the treatment to up to 6 years
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Locoregional control rates
Time Frame: Up to 6 years
|
Ninety percent confidence intervals using the exact binomial distribution will be presented.
Kaplan-Meier product limit curves will be calculated.
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Up to 6 years
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Disease control rates
Time Frame: Up to 6 years
|
Ninety percent confidence intervals using the exact binomial distribution will be presented.
Kaplan-Meier product limit curves will be calculated.
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Up to 6 years
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Locoregional recurrence rates
Time Frame: At 3 years
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Ninety percent confidence intervals using the exact binomial distribution will be presented.
Kaplan-Meier product limit curves will be calculated.
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At 3 years
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Time to progression
Time Frame: From the date of registration to the date of progressive disease or death from any cause
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Time to progression using Kaplan-Meier product limit curves will be calculated.
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From the date of registration to the date of progressive disease or death from any cause
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Overall survival time
Time Frame: From the date of registration to the date of death or date of last patient contact if censored
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Overall survival using Kaplan-Meier product limit curves will be calculated.
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From the date of registration to the date of death or date of last patient contact if censored
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Pharmacokinetics of sunitinib malate delivered by percutaneous gastrostomy tube
Time Frame: Prior to and up to 24 hours after the start of sunitinib malate
|
Prior to and up to 24 hours after the start of sunitinib malate
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Victoria Villaflor, University of Chicago Comprehensive Cancer Center
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Pathologic Processes
- Respiratory Tract Diseases
- Neoplasms by Histologic Type
- Neoplasms
- Neoplasms by Site
- Neoplasms, Glandular and Epithelial
- Disease Attributes
- Respiratory Tract Neoplasms
- Pharyngeal Neoplasms
- Otorhinolaryngologic Neoplasms
- Nasopharyngeal Diseases
- Pharyngeal Diseases
- Stomatognathic Diseases
- Otorhinolaryngologic Diseases
- Mouth Diseases
- Neoplastic Processes
- Paranasal Sinus Diseases
- Nose Diseases
- Neoplasm Metastasis
- Neoplasms, Squamous Cell
- Nasopharyngeal Neoplasms
- Salivary Gland Diseases
- Mouth Neoplasms
- Tongue Diseases
- Nose Neoplasms
- Head and Neck Neoplasms
- Carcinoma
- Nasopharyngeal Carcinoma
- Recurrence
- Carcinoma, Squamous Cell
- Squamous Cell Carcinoma of Head and Neck
- Neoplasms, Unknown Primary
- Oropharyngeal Neoplasms
- Salivary Gland Neoplasms
- Laryngeal Neoplasms
- Laryngeal Diseases
- Carcinoma, Verrucous
- Tongue Neoplasms
- Paranasal Sinus Neoplasms
- Physiological Effects of Drugs
- Molecular Mechanisms of Pharmacological Action
- Enzyme Inhibitors
- Antineoplastic Agents
- Immunologic Factors
- Angiogenesis Inhibitors
- Angiogenesis Modulating Agents
- Growth Substances
- Growth Inhibitors
- Protein Kinase Inhibitors
- Antibodies
- Sunitinib
- Immunoglobulins
- Antibodies, Monoclonal
- Antineoplastic Agents, Immunological
- Cetuximab
Other Study ID Numbers
- NCI-2009-00279
- N01CM62201 (U.S. NIH Grant/Contract)
- UCIRB 16051B
- CDR0000601544
- UCIRB-16051B
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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