Chemotherapy With or Without Bevacizumab in Treating Patients With Recurrent or Metastatic Head and Neck Cancer

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Basic Trial Information

PhaseTypeStatusAgeSponsorProtocol IDs
Phase IIITreatmentClosed18 and overNCINCI-2009-00507
CDR0000582533, E1305, U10CA180820, U10CA021115, ECOG-E1305, NCT00588770

Trial Description

Summary

This randomized phase III trial studies chemotherapy to see how well it works with or without bevacizumab in treating patients with head and neck cancer that has come back (recurrent) or that has spread to other parts of the body (metastatic). Drugs used in chemotherapy, such as docetaxel, cisplatin, carboplatin, and fluorouracil, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Monoclonal antibodies, such as bevacizumab, may interfere with the ability of tumor cells to grow and spread. Bevacizumab may also make tumor cells more sensitive to chemotherapy and stop the growth of head and neck cancer by blocking blood flow to the tumor. It is not yet known whether combination chemotherapy is more effective when given with or without bevacizumab in treating patients with head and neck cancer.

Further Study Information

PRIMARY OBJECTIVES:

I. To compare the overall survival of patients with recurrent or metastatic head and neck cancer treated with standard platinum-based chemotherapy with or without bevacizumab.

SECONDARY OBJECTIVES:

I. To assess toxicities with the addition of bevacizumab to each platinum-doublet (cisplatin/docetaxel, carboplatin/docetaxel, cisplatin/fluorouracil [5-FU], carboplatin/5-FU).

II. To compare the objective response rates and the progression-free survival achieved with the above therapies.

III. To collect blood samples before and after therapy for future correlative studies.

IV. To collect tumor tissue samples available at baseline from prior diagnostic procedures for future correlative studies.

OUTLINE: After the physician decides which chemotherapy doublet to use, patients are randomized to 1 of 2 treatment arms for that chemotherapy combination.

ARM IA: Patients receive chemotherapy comprising docetaxel intravenously (IV) over 1 hour and cisplatin IV over 1-2 hours on day 1. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.

ARM IB: Patients receive bevacizumab IV over 30-90 minutes on day 1 and docetaxel and cisplatin as in Arm IA.

ARM IIA: Patients receive docetaxel IV over 1 hour and carboplatin IV over 30 minutes on day 1. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.

ARM IIB: Patients receive bevacizumab as in arm IB and docetaxel and carboplatin as in Arm IIA.

ARM IIIA: Patients receive cisplatin IV over 1-2 hours on day 1 and fluorouracil IV continuously on days 1-4. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.

ARM IIIB: Patients receive bevacizumab as in Arm IB and cisplatin and fluorouracil as in Arm IIIA.

ARM IVA: Patients receive carboplatin IV over 30 minutes on day 1 and fluorouracil IV continuously on days 1-4. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.

ARM IVB: Patients receive bevacizumab as in Arm IB and carboplatin and fluorouracil as in Arm IVA.

After completion of study treatment, patients are followed up every 3 months for 2 years and then every 6 months for 3 years.

Eligibility Criteria

Inclusion Criteria:

  • Patients must have histologically or cytologically confirmed squamous cell cancer of the head and neck (SCCHN), from any primary site, including unknown primary cancers of the head and neck; patient must not have nasopharyngeal carcinoma of histologic types World Health Organization (WHO) 2 or 3 or squamous cell carcinoma that originated in the skin
  • Patients must have SCCHN that is either (a) recurrent, judged incurable by surgery or radiation or (b) metastatic; NOTE: Patients who refuse radical resection for recurrent disease are eligible; NOTE: A second primary squamous cell carcinoma of the head and neck is allowed if eligibility is based on a recurrent or metastatic first primary squamous cell carcinoma of the head and neck
  • No prior chemotherapy or biologic/molecular targeted therapy for recurrent or metastatic SCCHN
  • Patients may have received one regimen of induction, concomitant chemoradiotherapy and/or adjuvant chemotherapy as part of initial potential curative therapy but must not have received prior chemotherapy for recurrent or metastatic disease
  • A minimum of 4 months is required between last dose of chemotherapy or chemoradiotherapy and study treatment; in addition patients must be progression-free for at least 4 months after completion of chemotherapy or chemoradiotherapy or radiation plus cetuximab given with a curative intent; (cetuximab therapy: 4 months is required between last dose of chemotherapy or chemoradiotherapy and study treatment if part of concurrent regimen, 8 weeks if part of adjuvant regimen post radiation)
  • Patients having progression after 2 cycles of induction chemotherapy are not eligible for the study
  • No prior bevacizumab is allowed
  • A maximum of one prior radiotherapy regimen, curative or palliative, to the head and neck is allowed; if the radiation is combined with chemotherapy and/or cetuximab, a minimum of 4 months must elapse between the end of radiotherapy and registration; if the radiation is given alone, a minimum of 8 weeks must elapse between the end of radiotherapy and registration; a minimum of 3 weeks must elapse between prior radiation to other areas and registration
  • Patients must not be receiving any other investigational agent while on the study
  • Eastern Cooperative Oncology Group (ECOG) performance status of 0-1
  • Patients must have recovered to grade 1 or better from any acute effects of prior surgery, chemotherapy, or radiation therapy, and should be > 4 weeks post surgery; chronic late xerostomia, speech and swallowing abnormalities resulting from prior radiation or surgery are permitted if nutritional status is stable
  • Patients must have measurable disease based on Response Evaluation Criteria in Solid Tumors (RECIST); baseline measurements and evaluations of all sites of disease must be obtained =< 4 weeks prior to randomization; 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)
  • Absolute neutrophil count (ANC) >= 1500/mm^3
  • Hemoglobin (Hgb) >= 8.0 g/dL
  • Platelet count >= 100,000/mm^3
  • Creatinine clearance of >= 60 ml/min; creatinine clearance may be measured or calculated; if calculating, creatinine clearance, use the Cockroft-Gault formula
  • Total bilirubin within normal limits (must be obtained =< 2 weeks prior to randomization)
  • Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) must be within the range allowing for eligibility
  • Alkaline phosphatase normal AND AST or ALT =< 5 x upper limit of normal (ULN)
  • Alkaline phosphatase > 1 but =< 2.5 x ULN AND AST or ALT > 1 but =< 1.5 x ULN
  • Alkaline phosphatase > 2.5 but =< 5 x ULN AND AST or ALT normal
  • Alkaline phosphatase must be within the range allowing for eligibility
  • Urine dipstick must be =< 0-1+ within 2 weeks (14 days) of randomization; if urine dipstick result is > 1+, a calculation of urine protein creatinine (UPC) ratio is required; patients must have a UPC ratio < 1.0 to participate in the study; NOTE: UPC ratio of spot urine is an estimation of the 24 urine protein excretion - a UPC ratio of 1 is roughly equivalent to a 24-hour urine protein of 1 gm
  • No known brain metastases
  • Patients who meet the following criteria will be excluded:
  • Tumors that invade major vessels (e.g. the carotid) as shown unequivocally by imaging studies
  • Central (i.e. within 2 cm from the hilum) lung metastases that are cavitary as shown unequivocally by imaging studies
  • Any prior history of bleeding related to the current head and neck cancer
  • History of gross hemoptysis (bright red blood of 1/2 teaspoon or more per episode of coughing) =< 3 months prior to enrollment
  • No history of coagulopathy or hemorrhagic disorders
  • Patients should not have a history of thrombosis (e.g. pulmonary embolism or deep venous thrombosis) currently requiring therapeutic anticoagulation (prophylactic use of warfarin 1 mg per day is allowed) and international normalized ratio (INR) should be < 1.5 at registration
  • Patients must not be receiving chronic daily treatment with aspirin (> 325 mg/day) or non-steroidal anti-inflammatory agents (NSAID's) known to inhibit platelet function; the use of anti-platelet agents (e.g. dipyridamole [Persantine], ticlopidine [Ticlid], clopidogrel [Plavix]) is allowed only if patient is not receiving aspirin or NSAID's known to inhibit platelet function
  • No hypercalcemia related to head and neck cancer
  • 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 3 years post diagnosis
  • No current peripheral neuropathy >= grade 2 at time of randomization
  • Patients must not have any co-existing condition that would preclude full compliance with the study
  • No prior history of severe hypersensitivity reaction to docetaxel or other drugs formulated with polysorbate 80, if the physician's choice of chemotherapy regimen is docetaxel
  • All patients must have blood pressure =< 150/90 =< 2 weeks prior to randomization; patients with history of hypertension must be well-controlled upon study entry (=< 150/90) on a stable regimen of anti-hypertensive therapy
  • No major surgical procedure, open biopsy, or significant traumatic injury within 28 days prior to study enrollment, or anticipation of need for major surgical procedure during the course of the study
  • No unstable angina or myocardial infarction within the previous 6 months; no symptomatic congestive heart failure, New York Heart Association (NYHA) grade II or greater; no history of aortic dissection or presence of aneurysm > 6 cm (or at high risk for rupture); no serious cardiac arrhythmia requiring medication (history of chronic atrial fibrillation or other atrial arrhythmia with controlled rate on medication is allowed); no clinically significant peripheral vascular disease manifested by intermittent claudication or need for vascular intervention; no history of aortic dissection; no history of any central nervous system (CNS) cerebrovascular ischemia or stroke within the last 6 months; no active serious infection
  • Patients should not have prior history of a serious human anti-human antibody (HAHA) reaction; patients with known hypersensitivity to Chinese hamster ovary cell products or other recombinant human antibodies are not eligible
  • Women must not be pregnant or breast feeding; pregnant women are excluded from this study; women of child-bearing potential and men must agree to total abstinence or to use adequate hormonal or barrier method of birth control prior to study entry and for the duration of study participation; should a woman become pregnant or suspect she is pregnant while in this study, she should inform her treating physician immediately; all females of childbearing potential must have a blood test or urine study within 2 weeks prior to randomization to rule out pregnancy
  • Human immunodeficiency virus (HIV)-positive patients receiving combination anti-retroviral therapy are excluded from the study; appropriate studies will be undertaken in patients receiving combination anti-retroviral therapy when indicated
  • No history of abdominal fistula, gastrointestinal perforation, or intra-abdominal abscess within 6 months prior to registration

Trial Contact Information

Trial Lead Organizations/Sponsors

National Cancer Institute

    Athanassios (Ethan) Argiris, Principal Investigator

    Trial Sites

    U.S.A.

    California
    La Jolla

    Rebecca and John Moores UCSD Cancer Center

    Athanassios Argiris
    Ph: 210-616-5798
    Email: argiris@uthscsa.edu

    Los Angeles

    Kaiser Permanente Medical Center - Los Angeles

    Han A Koh
    Ph: 626-564-3455

    Colorado
    Denver

    CCOP - Colorado Cancer Research Program

    Keren Sturtz
    Ph: 888-785-6789

    Florida
    Boca Raton

    Eugene M. and Christine E. Lynn Cancer Institute at Boca Raton Community Hospital - Main Campus

    Hilary I Gomolin
    Ph: 561-955-6400

    Pensacola

    Sacred Heart Medical Oncology Group

    Ranjith B Dissanayake
    Ph: 850-416-6316
    Email: ttamayo@shhpens.org

    Georgia
    Atlanta

    Emory University Hospital Midtown

    Athanassios Argiris
    Ph: 210-450-3838
    Email: athanassios.argiris@gmail.com

    Hawaii
    Aiea

    Kapiolani Medical Center at Pali Momi

    Jonathan K Cho
    Ph: 808-586-2979

    Honolulu

    Hawaii Medical Center - East

    Jonathan K Cho
    Ph: 808-586-2979

    Kapiolani Medical Center for Women and Children

    Jonathan K Cho
    Ph: 808-586-2979

    OnCare Hawaii, Incorporated - Kuakini

    Jonathan K Cho
    Ph: 808-586-2979

    OnCare Hawaii, Incorporated - Lusitana

    Jonathan K Cho
    Ph: 808-586-2979

    Queen's Cancer Institute at Queen's Medical Center

    Jonathan K Cho
    Ph: 808-586-2979

    Straub Clinic and Hospital, Incorporated

    Jonathan K Cho
    Ph: 808-586-2979

    Wailuku

    Maui Memorial Medical Center

    Jonathan K Cho
    Ph: 808-586-2979

    Pacific Cancer Institute - Maui

    Jonathan K Cho
    Ph: 808-586-2979

    Illinois
    La Grange

    La Grange Memorial Hospital

    Renee H. Jacobs
    Ph: 630-856-7526

    Indiana
    South Bend

    CCOP - Northern Indiana CR Consortium

    Bilal Ansari
    Ph: 574-237-1328

    Iowa
    Des Moines

    CCOP - Iowa Oncology Research Association

    Robert J Behrens
    Ph: 515-282-2921

    Massachusetts
    Boston

    Tufts Medical Center Cancer Center

    Athanassios Argiris
    Ph: 210-616-5798
    Email: argiris@uthscsa.edu

    Montana
    Billings

    CCOP - Montana Cancer Consortium

    Benjamin Thomas Marchello
    Ph: 800-648-6274

    Nebraska
    Omaha

    CCOP - Missouri Valley Cancer Consortium

    Gamini S. Soori
    Ph: 402-991-8070ext202
    Email: mwilwerding@mvcc.cc

    Methodist Estabrook Cancer Center

    Yungpo B Su
    Ph: 402-354-5144

    Oncology Hematology West PC

    Gamini S. Soori
    Ph: 402-991-8070ext202
    Email: mwilwerding@mvcc.cc

    New Jersey
    Hackensack

    CCOP - Northern New Jersey

    Donna T McNamara
    Ph: 201-996-2879

    New Mexico
    Albuquerque

    Lovelace Medical Center - Downtown

    Athanassios Argiris
    Ph: 210-616-5798
    Email: argiris@uthscsa.edu

    University of New Mexico Cancer Center

    Athanassios Argiris
    Ph: 210-616-5798
    Email: argiris@uthscsa.edu

    New York
    Brooklyn

    Veterans Affairs Medical Center - Brooklyn

    Andrea Nadine Wiesel Leaf
    Ph: 800-877-6976

    North Dakota
    Bismarck

    Bismarck Cancer Center

    Edward J. Wos
    Ph: 701-323-5760
    Email: tfischer@mohs.org

    Ohio
    Columbus

    Arthur G. James Cancer Hospital and Richard J. Solove Research Institute at Ohio State University Comprehensive Cancer Center

    Athanassios Argiris
    Ph: 210-616-5798
    Email: argiris@uthscsa.edu

    Oklahoma
    Oklahoma City

    Cancer Care Associates - West

    Athanassios Argiris
    Ph: 210-616-5798
    Email: argiris@uthscsa.edu

    Oregon
    Salem

    Salem Hospital Regional Cancer Care Services

    Edward Peter Orlowski
    Ph: 503-561-2618

    Pennsylvania
    Philadelphia

    Abramson Cancer Center of the University of Pennsylvania

    Athanassios Argiris
    Ph: 210-616-5798
    Email: argiris@uthscsa.edu

    West Chester

    Cancer Center of Chester County

    William E. Luginbuhl
    Ph: 610-431-5297

    West Reading

    McGlinn Family Regional Cancer Center at Reading Hospital and Medical Center

    Terrence P. Cescon
    Ph: 610-988-9323

    West Virginia
    Huntington

    Edwards Comprehensive Cancer Center at Cabell Huntington Hospital

    Maria-Rosalia B. Tria Tirona
    Ph: 304-399-6617

    Wisconsin
    Antigo

    Langlade Memorial Hospital

    Hamied R. Rezazadeh
    Ph: 877-405-6866

    Mequon

    Columbia Saint Mary's Hospital - Ozaukee

    Charles H. I. Tiber
    Ph: 414-326-2675
    Email: clinicaltrials@columbia-stmarys.org

    Milwaukee

    Columbia-Saint Mary's Cancer Care Center

    Charles H. I. Tiber
    Ph: 414-326-2675
    Email: clinicaltrials@columbia-stmarys.org

    Racine

    All Saints Cancer Center at Wheaton Franciscan Healthcare

    Young M Choi
    Ph: 414-874-4541
    Email: Kelli.holton@wfhc.org

    Wausau

    University of Wisconcin Cancer Center at Aspirus Wausau Hospital

    Hamied R. Rezazadeh
    Ph: 877-405-6866

    Link to the current ClinicalTrials.gov record.
    NLM Identifier NCT00588770
    ClinicalTrials.gov processed this data on May 21, 2015

    Note: Information about this trial is from the ClinicalTrials.gov database. The versions designated for health professionals and patients contain the same text. Minor changes may be made to the ClinicalTrials.gov record to standardize the names of study sponsors, sites, and contacts. Cancer.gov only lists sites that are recruiting patients for active trials, whereas ClinicalTrials.gov lists all sites for all trials. Questions and comments regarding the presented information should be directed to ClinicalTrials.gov.