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Chemotherapy With or Without Bevacizumab in Treating Patients With Recurrent or Metastatic Head and Neck Cancer
This study is currently recruiting participants.
Verified February 2012 by National Cancer Institute (NCI)

First Received on December 28, 2007.   Last Updated on February 7, 2012   History of Changes
Sponsor: Eastern Cooperative Oncology Group
Collaborator: National Cancer Institute (NCI)
Information provided by: National Cancer Institute (NCI)
ClinicalTrials.gov Identifier: NCT00588770
  Purpose

RATIONALE: 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, can block tumor growth in different ways. Some block the ability of tumor cells to grow and spread. Others find tumor cells and help kill them or carry tumor-killing substances to them. 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.

PURPOSE: This randomized phase III trial is studying chemotherapy to see how well it works with or without bevacizumab in treating patients with recurrent or metastatic head and neck cancer.


Condition Intervention Phase
Head and Neck Cancer
Biological: bevacizumab
Drug: carboplatin
Drug: cisplatin
Drug: docetaxel
Drug: fluorouracil
Phase 3

Study Type: Interventional
Study Design: Allocation: Randomized
Masking: Open Label
Primary Purpose: Treatment
Official Title: A Phase III Randomized Trial of Chemotherapy With or Without Bevacizumab In Patients With Recurrent Or Metastatic Head and Neck Cancer

Resource links provided by NLM:


Further study details as provided by National Cancer Institute (NCI):

Primary Outcome Measures:
  • Overall survival [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Toxicity [ Designated as safety issue: Yes ]
  • Objective response rate [ Designated as safety issue: No ]
  • Progression-free survival [ Designated as safety issue: No ]
  • Impact of comorbidity [ Designated as safety issue: Yes ]

Estimated Enrollment: 400
Study Start Date: August 2008
Estimated Primary Completion Date: August 2013 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: Arm I
Patients receive chemotherapy comprising docetaxel IV over 1 hour and cisplatin IV over 1-2 hours on day 1. Treatment repeats every 21 days in the absence of disease progression or unacceptable toxicity.
Drug: cisplatin
Given IV
Drug: docetaxel
Given IV
Experimental: Arm II
Patients receive cisplatin IV over 1-2 hours on day 1 and fluorouracil IV continuously over days 1-4. Treatment repeats every 21 days in the absence of disease progression or unacceptable toxicity.
Drug: cisplatin
Given IV
Drug: fluorouracil
Given IV
Experimental: Arm III
Patients receive carboplatin IV over 30 minutes and docetaxel IV over 1 hour on day 1. Treatment repeats every 21 days in the absence of disease progression or unacceptable toxicity.
Drug: carboplatin
Given IV
Drug: docetaxel
Given IV
Experimental: Arm IV
Patients receive carboplatin IV over 30 minutes on day 1 and fluorouracil IV continuously on days 1-4. Treatment repeats every 21 days in the absence of disease progression or unacceptable toxicity.
Drug: carboplatin
Given IV
Drug: fluorouracil
Given IV
Experimental: Arm V
Patients receive chemotherapy as in arm I and bevacizumab IV over 30-90 minutes on day 1. Treatment repeats every 21 days in the absence of disease progression or unacceptable toxicity.
Biological: bevacizumab
Given IV
Drug: cisplatin
Given IV
Drug: docetaxel
Given IV
Experimental: Arm VI
Patients receive chemotherapy as in arm II and bevacizumab as in arm V. Treatment repeats every 21 days in the absence of disease progression or unacceptable toxicity.
Biological: bevacizumab
Given IV
Drug: cisplatin
Given IV
Drug: fluorouracil
Given IV
Experimental: Arm VII
Patients receive chemotherapy as in arm III and bevacizumab as in arm V. Treatment repeats every 21 days in the absence of disease progression or unacceptable toxicity.
Biological: bevacizumab
Given IV
Drug: carboplatin
Given IV
Drug: docetaxel
Given IV
Experimental: Arm VIII
Patients receive chemotherapy as in arm IV and bevacizumab as in arm V. Treatment repeats every 21 days in the absence of disease progression or unacceptable toxicity.
Biological: bevacizumab
Given IV
Drug: carboplatin
Given IV
Drug: fluorouracil
Given IV

Detailed Description:

OBJECTIVES:

Primary

  • To compare the overall survival of patients with recurrent or metastatic squamous cell carcinoma of the head and neck treated with standard platinum-based chemotherapy with or without bevacizumab.

Secondary

  • To assess toxicities with the addition of bevacizumab to each platinum doublet (cisplatin/docetaxel, carboplatin/docetaxel, cisplatin/fluorouracil, carboplatin/fluorouracil).
  • To compare the objective response rates and the progression-free survival achieved with the above therapies.

OUTLINE: This is a multicenter study. Patients are stratified by performance status (0 vs 1), weight loss (< 5% vs ≥ 5% of total body weight in the past 6 months), prior radiotherapy to head and neck (yes vs no), and chemotherapy regimen (cisplatin/docetaxel vs carboplatin/docetaxel vs cisplatin/fluorouracil vs carboplatin/fluorouracil). Patients are randomized to 1 of 8 treatment arms.

  • Arm I (cisplatin/docetaxel): Patients receive chemotherapy comprising docetaxel IV over 1 hour and cisplatin IV over 1-2 hours on day 1.
  • Arm II (cisplatin/fluorouracil): Patients receive cisplatin IV over 1-2 hours on day 1 and fluorouracil IV continuously over days 1-4.
  • Arm III (carboplatin/docetaxel): Patients receive carboplatin IV over 30 minutes and docetaxel IV over 1 hour on day 1.
  • Arm IV (carboplatin/fluorouracil): Patients receive carboplatin IV over 30 minutes on day 1 and fluorouracil IV continuously on days 1-4.
  • Arm V (cisplatin/docetaxel): Patients receive chemotherapy as in arm I and bevacizumab IV over 30-90 minutes on day 1.
  • Arm VI (cisplatin/fluorouracil): Patients receive chemotherapy as in arm II and bevacizumab as in arm V.
  • Arm VII (carboplatin/docetaxel): Patients receive chemotherapy as in arm III and bevacizumab as in arm V.
  • Arm VIII (carboplatin/fluorouracil): Patients receive chemotherapy as in arm IV and bevacizumab as in arm V.

In all arms, treatment repeats every 21 days in the absence of disease progression or unacceptable toxicity.*

NOTE: *Treatment with chemotherapy may be discontinued if there is maximum response (i.e., no improvement in tumor measurements for 2 or more courses) after course 6; bevacizumab administration continues until disease progression in arm II.

After completion of study treatment, patients are followed every 3-6 months for 5 years.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

DISEASE CHARACTERISTICS:

  • Histologically or cytologically confirmed squamous cell carcinoma of the head and neck (SCCHN) from any primary site, including unknown primary cancers of the head and neck

    • No nasopharyngeal carcinoma of histologic types WHO 2 or 3
    • No squamous cell carcinoma that originated in the skin
  • Recurrent disease, incurable disease as determined by surgery or radiation, or metastatic disease

    • A second primary squamous cell carcinoma of the head and neck allowed if eligibility is based on a recurrent or metastatic first primary squamous cell carcinoma of the head and neck
  • Patients who refuse radical resection for recurrent disease are eligible
  • Patients must have measurable disease based on RECIST

    • Disease in previously irradiated sites is considered measurable if there has been unequivocal disease progression or biopsy-proven residual carcinoma after radiotherapy
    • Persistent disease after radiotherapy must be biopsy proven at least 8 weeks after completion of radiotherapy (radiographic findings are acceptable providing that clearcut measurements can be made)
  • Patients must be progression-free for at least 6 months after completion of chemotherapy or chemoradiotherapy or radiotherapy plus cetuximab given as part of initial potential curative therapy (if received such prior therapy)

    • At least 6 months since completion of prior concurrent radiotherapy plus cetuximab (8 weeks for cetuximab given as part of adjuvant regimen post radiotherapy)
    • Patients having progression after 2 courses of induction chemotherapy are not eligible
  • No tumors that invade major vessels (e.g., the carotid) as shown unequivocally by imaging studies
  • No central (i.e., within 2 cm from the hilum) lung metastases that are cavitary as shown unequivocally by imaging studies
  • No known brain metastases

PATIENT CHARACTERISTICS:

  • ECOG performance status 0-1
  • ANC ≥ 1,500/mm^3
  • Hemoglobin ≥ 8.0 g/dL
  • Platelet count ≥ 100,000/mm^3
  • Creatinine clearance ≥ 60 mL/min
  • Total bilirubin normal
  • AST or ALT and alkaline phosphatase must meet one of the following criteria:

    • 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
  • Urine dipstick must be < 0-1+ within 2 weeks of randomization OR urine protein:creatinine ratio < 1 OR 24-hour urine protein < 1 g
  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective contraception
  • Patients who meet the following criteria are excluded:

    • Any prior history of bleeding related to the current head and neck cancer
    • History of gross hemoptysis (bright red blood of ½ teaspoon or more per episode of coughing) ≤ 3 months prior to enrollment
  • No history of coagulopathy or hemorrhagic disorders
  • No history of thrombosis (e.g., pulmonary embolism or deep venous thrombosis) currently requiring therapeutic anticoagulation (prophylactic use of warfarin 1 mg/day is allowed)
  • INR < 1.5 at registration
  • No hypercalcemia related to head and neck cancer
  • Patients with a prior history of squamous cell or basal cell carcinoma of the skin or in situ carcinoma of the cervix 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
  • No current peripheral neuropathy ≥ grade 2
  • Patients must not have any co-existing condition that would preclude full compliance with the study
  • No history of severe hypersensitivity reaction to docetaxel or other drugs formulated with polysorbate 80 (if the physician's choice of chemotherapy is docetaxel)
  • Patients must have a blood pressure (BP) ≤ 150/90 within 2 weeks prior to randomization

    • Patients with a history of hypertension must be well-controlled upon study entry (BP ≤ 150/90 mm Hg) on a stable regimen of anti-hypertensive therapy
  • No history of abdominal fistula, gastrointestinal perforation, or intra-abdominal abscess within 6 months prior to registration
  • No significant traumatic injury within the past 28 days
  • No serious nonhealing wound, ulcer, or bone fracture
  • No unstable angina or myocardial infarction within the past 6 months
  • No symptomatic congestive heart failure or New York Heart Association (NYHA) class II-IV heart disease
  • 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 any CNS cerebrovascular ischemia or stroke within the past 6 months
  • No active serious infection
  • No 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
  • Chronic late xerostomia, speech and swallowing abnormalities, resulting from prior radiation or surgery, allowed provided nutritional status is stable
  • No other prior malignancy except curatively treated squamous cell or basal carcinoma of the skin, in situ cervical cancer, or malignancy for which the patient has been curatively treated and remains disease-free for the past 3 years

PRIOR CONCURRENT THERAPY:

  • See Disease Characteristics
  • Patients must have recovered to grade 1 or better from the effects of any prior surgery, chemotherapy, or radiotherapy AND > 4 weeks post-surgery
  • No more than one prior radiotherapy regimen, curative or palliative, to the head and neck allowed

    • At least 4 months since prior radiotherapy in combination with chemotherapy and/or cetuximab
    • At least 8 weeks since prior radiotherapy given alone
  • At least 3 weeks since prior radiotherapy to other areas
  • No prior bevacizumab
  • No prior chemotherapy or biologic/molecular-targeted therapy for recurrent or metastatic SCCHN

    • Patients may have received one regimen of induction, concurrent chemoradiotherapy, and/or adjuvant chemotherapy as part of initial potential curative therapy

      • A minimum of 6 months is required between last dose of chemotherapy or chemoradiotherapy and study treatment
  • No major surgical procedure or open biopsy within 28 days prior to study enrollment, or anticipation of need for major surgical procedure during the course of the study
  • More than 4 weeks since prior surgery
  • No other concurrent investigational agent
  • Patients must not be receiving chronic daily treatment with aspirin (> 325 mg/day) or nonsteroidal anti-inflammatory agents (NSAIDs) known to inhibit platelet function

    • The use of anti-platelet agents (e.g., dipyridamole [Persatine], ticlopidine [Ticlid], or clopidogrel [Plavix]) is allowed only if patient is not receiving aspirin or NSAIDs known to inhibit platelet function
  • No HIV-positive patients on combination antiretroviral therapy
  • No other concurrent chemotherapy, immunotherapy, antitumor hormonal therapy (excluding contraceptives and replacement steroids), radiotherapy, or experimental medications
  • No concurrent amifostine
  • No concurrent bisphosphonates for bone metastasis unless initiated > 3 months before study entry
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00588770

  Show 421 Study Locations
Sponsors and Collaborators
Eastern Cooperative Oncology Group
Investigators
Study Chair: Athanassios Argiris, MD University of Pittsburgh
Investigator: Panos Savvides, MD Case Comprehensive Cancer Center
  More Information

Additional Information:
No publications provided

Responsible Party: Robert L. Comis, ECOG Group Chair's Office
ClinicalTrials.gov Identifier: NCT00588770     History of Changes
Other Study ID Numbers: CDR0000582533, ECOG-E1305
Study First Received: December 28, 2007
Last Updated: February 7, 2012
Health Authority: Unspecified

Keywords provided by National Cancer Institute (NCI):
recurrent squamous cell carcinoma of the hypopharynx
stage IV squamous cell carcinoma of the hypopharynx
stage IV squamous cell carcinoma of the larynx
stage IV verrucous carcinoma of the larynx
recurrent squamous cell carcinoma of the larynx
recurrent verrucous carcinoma of the larynx
recurrent squamous cell carcinoma of the lip and oral cavity
stage IV squamous cell carcinoma of the lip and oral cavity
recurrent verrucous carcinoma of the oral cavity
stage IV verrucous carcinoma of the oral cavity
metastatic squamous neck cancer with occult primary squamous cell carcinoma
recurrent metastatic squamous neck cancer with occult primary
untreated metastatic squamous neck cancer with occult primary
recurrent squamous cell carcinoma of the nasopharynx
stage IV squamous cell carcinoma of the nasopharynx
recurrent squamous cell carcinoma of the oropharynx
stage IV squamous cell carcinoma of the oropharynx
recurrent squamous cell carcinoma of the paranasal sinus and nasal cavity
stage IV squamous cell carcinoma of the paranasal sinus and nasal cavity
recurrent salivary gland cancer
salivary gland squamous cell carcinoma
stage IV salivary gland cancer
tongue cancer

Additional relevant MeSH terms:
Head and Neck Neoplasms
Neoplasms by Site
Neoplasms
Docetaxel
Bevacizumab
Cisplatin
Fluorouracil
Carboplatin
Antineoplastic Agents
Therapeutic Uses
Pharmacologic Actions
Radiation-Sensitizing Agents
Physiological Effects of Drugs
Antimetabolites
Molecular Mechanisms of Pharmacological Action
Antimetabolites, Antineoplastic
Immunosuppressive Agents
Immunologic Factors
Angiogenesis Inhibitors
Angiogenesis Modulating Agents
Growth Substances
Growth Inhibitors

ClinicalTrials.gov processed this record on May 22, 2012