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Cabozantinib in Combination With Cetuximab in Patients With Recurrent or Metastatic Head and Neck Squamous Cell Cancer

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ClinicalTrials.gov Identifier: NCT03667482
Recruitment Status : Recruiting
First Posted : September 12, 2018
Last Update Posted : November 1, 2018
Sponsor:
Information provided by (Responsible Party):
Memorial Sloan Kettering Cancer Center

Brief Summary:
The purpose of this study is to test the safety of cabozantinib, at different doses, in combination with cetuximab to find out what effects, if any, this combined treatment has on people with HNSCC.

Condition or disease Intervention/treatment Phase
Head and Neck Squamous Cell Cancer Recurrent Head and Neck Squamous Cell Cancer Metastatic Head and Neck Squamous Cell Cancer Drug: Cabozantinib Drug: Cetuximab Phase 1

Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 24 participants
Intervention Model: Single Group Assignment
Intervention Model Description: A standard 3+3 design will be used to find the maximum tolerated dose (MTD) from 3 testing dose levels: 20, 40, and 60.
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Phase 1 Study of Concurrent Cabozantinib and Cetuximab in Recurrent or Metastatic Head and Neck Squamous Cell Cancer
Actual Study Start Date : September 7, 2018
Estimated Primary Completion Date : September 2020
Estimated Study Completion Date : September 2020

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: Cabozantinib in Combination With Cetuximab
Treatment will be initiated with a 400 mg/m2 loading dose of cetuximab followed by 240 mg/m2 cetuximab IV weekly. Cabozantinib will be initiated at 40 mg PO daily, with subsequent 20 mg or 40 mg doses as tolerated per the study design.
Drug: Cabozantinib
Cabozantinib will be initiated at 40 mg PO daily, with subsequent 20 mg or 40 mg doses as tolerated per the study design.

Drug: Cetuximab
400 mg/m2 loading dose of cetuximab followed by 240 mg/m2 cetuximab IV weekly.




Primary Outcome Measures :
  1. maximum tolerated dose (MTD) [ Time Frame: 2 years ]

    from 3 testing dose levels: 20, 40, and 60. Three patients will be enrolled at the dose level 0 of 40 mg. The dose escalation scheme is as follows:

    1. If none of the initial three patients at a given dose level experience DLT within 4 weeks, the next dose level will be studied.
    2. If one of the initial three patients at a given dose level experiences DLT, three additional patients will be treated at the same dose level. Escalation will continue only if there is no additional DLT observed.If two or more patients experience DLT at a given dose, the previous dose level will be studied. Should two or more patients experience the DLT at the lowest dose level (20 mg), the study will be halted, and alternative dosing will be considered.

    4. The highest dose level with no more than one DLT among six patients will be declared as the MTD. If only three patients were treated at a dose under consideration as the MTD, an additional three patients will be treated at that level.




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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Histologically or cytologically confirmed diagnosis of squamous cell carcinoma of the head and neck and is refractory to or progressed (or relapsed) following standard therapies (including cetuximab) or has disease for which no standard therapy exists.
  • Disease must be considered incurable. Incurable is defined as metastatic disease or a local or regional recurrence in a previously irradiated site that is unresectable (or patient declines resection).
  • Measurable disease defined as lesions that can be accurately measured in at least one dimension (longest diameter to be recorded) as >10 mm with CT scan, as >20 mm by chest x-ray, or >10 mm with calipers by clinical exam.
  • Prior therapy with cisplatin, carboplatin, taxanes, nivolumab, pembrolizumab, methotrexate, 5-fluorouracil, or cetuximab is allowed. Patients in the expansion phase must be cetuximab refractory. Those in the escalation phase do not need to be cetuximab refractory.
  • Cetuximab refractory patients are those who have received either single agent cetuximab or cetuximab in combination with chemotherapy and have progressed after treatment.
  • Measurable disease per RECIST v1.1 as determined by the investigator;
  • The subject has had an assessment of all known disease sites e.g., by computerized tomography (CT) scan, magnetic resonance imaging (MRI), bone scan as appropriate, within 28 days before the first dose of cabozantinib;
  • The subject is ≥ 18 years old on the day of consent;
  • The subject has an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1;
  • Recovery to baseline or ≤ Grade 1 CTCAE v.4.0 from toxicities related to any prior treatments, unless AE(s) are clinically nonsignificant and/or stable on supportive therapy;
  • The subject has organ and marrow function and laboratory values as follows within 14 days before the first dose of cabozantinib:

    1. The ANC ≥ 1500/mm3 without colony stimulating factor support;
    2. White blood cell count ≥ 2500/mm3 (≥ 2.5 GI/L).
    3. Platelets ≥ 100,000/mm3;
    4. Hemoglobin ≥ 9 g/dL;
    5. Bilirubin ≤ 1.5 x the ULN. For subjects with known Gilbert's disease, bilirubin ≤ 3.0 mg/dL;
    6. Albumin ≥ 2.8 g/dl;
    7. Creatinine ≤ 2.0 x ULN or creatinine clearance (CrCl) ≥ 40 mL/min. For creatinine clearance estimation, the Cockcroft and Gault equation should be used:

    i. Male: CrCl (mL/min) = (140 - age) × wt (kg) / (creatinine × 72); h. Female: Multiply above result by 0.85; Alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP) ≤ 3 x upper limit of normal (ULN). ALP ≤ 5 x ULN with documented bone metastases.

    i. Lipase < 2.0 x the upper limit of normal and no radiologic or clinical evidence of pancreatitis; j. UPCR ≤ 1; k. Phosphorus, calcium, magnesium and potassium ≥ LLN

  • The subject is capable of understanding and complying with the protocol requirements and has signed the informed consent document;
  • Sexually active subjects (men and women) must agree to use medically accepted barrier methods of contraception (e.g., male or female condom) during the course of the study and for 4 months after the last dose of study drug(s), even if oral contraceptives are also used. All subjects of reproductive potential must agree to use both a barrier method and a second method of birth control during the course of the study and for 4 months after the last dose of study drug(s);
  • Female subjects of childbearing potential must not be pregnant at screening. Females of childbearing potential are defined as premenopausal females capable of becoming pregnant (i.e., females who have had any evidence of menses in the past 12 months, with the exception of those who had prior hysterectomy). However, women who have been amenorrheic for 12 or more months are still considered to be of childbearing potential if the amenorrhea is possibly due to prior chemotherapy, antiestrogens, low body weight, ovarian suppression or other reasons.
  • No hypersensitivity reaction to cetuximab.

Exclusion Criteria:

  • Any patient with incurable disease who has not received cetuximab.
  • Any patient with active disease in the neck, or who has received > 70 Gy of XRT to the neck. This is defined as a growing tumor of the neck. Head and neck radiation within 6 months prior. Treatment areas should be healed with no sequelae from RT that would predispose to fistula formation.
  • A history of other malignancy ≤ 5 years previous with the exception of basal cell or squamous cell carcinoma of the skin which were treated with local resection only, carcinoma in situ of the cervix, synchronous H&N primaries or low grade tumors deemed cured and not treated with systemic therapy.
  • Receipt of any type of cytotoxic, biologic or other systemic anticancer therapy (including investigational) within 4 weeks before first dose of study treatment.
  • Prior treatment with cabozantinib;
  • Radiation therapy for bone metastasis within 2 weeks, any other external radiation therapy within 4 weeks before the first dose of study treatment. Systemic treatment with radionuclides within 6 weeks before the first dose of study treatment. Subjects with clinically relevant ongoing complications from prior radiation therapy are not eligible.;
  • Receipt of any type of small molecule kinase inhibitor (including investigational kinase inhibitor) within 14 days before the first dose of study treatment. Note: Subjects with prostate cancer currently receiving LHRH or GnRH agonists may be maintained on these agents;
  • The subject has received any other type of investigational agent within 28 days before the first dose of study treatment;
  • Known brain metastases or cranial epidural disease unless adequately treated with radiotherapy and/or surgery (including radiosurgery) and stable for at least 4 weeks before the first dose of study treatment. Eligible subjects must be neurologically asymptomatic and without corticosteroid treatment at the time of the start of study treatment;
  • The subject has prothrombin time (PT)/INR or partial thromboplastin time (PTT) test ≥ 1.3 x the laboratory ULN within 7 days before the first dose of study treatment;
  • Concomitant anticoagulation with oral anticoagulants (e.g., warfarin, direct thrombin and Factor Xa inhibitors) or platelet inhibitors (e.g., clopidogrel).

Allowed anticoagulants are the following:

  1. Low-dose aspirin for cardioprotection (per local applicable guidelines) is permitted.
  2. Low-dose low molecular weight heparins (LMWH) are permitted.
  3. Anticoagulation with therapeutic doses of LMWH is allowed in subjects without known brain metastases who are on a stable dose of LMWH for at least 6 weeks before first dose of study treatment, and who have had no clinically significant hemorrhagic complications from the anticoagulation regimen or the tumor.

    • The subject has experienced any of the following:

a. clinically-significant GI bleeding within 6 months before the first dose of study treatment; b. hemoptysis of ≥ 0.5 teaspoon (2.5ml) of red blood within 3 months before the first dose of study treatment;

  • Any other signs indicative of pulmonary hemorrhage within 3 months before the first dose of study treatment. Clinically significant hematuria, hematemesis, or hemoptysis of > 0.5 teaspoon (2.5 ml) of red blood, or other history of significant bleeding (e.g., pulmonary hemorrhage) within 12 weeks before first dose.
  • The subject has radiographic evidence of cavitating pulmonary lesion(s);
  • The subject has tumor invading or encasing any major blood vessels;
  • The subject has evidence of tumor invading the GI tract (esophagus, stomach, small or large bowel, rectum or anus), or any evidence of endotracheal or endobronchial tumor within 28 days before the first dose of cabozantinib;
  • Known brain metastases or cranial epidural disease unless adequately treated with radiotherapy and/or surgery (including radiosurgery) and stable for at least 4 weeks before the first dose of study treatment. Eligible subjects must be neurologically asymptomatic and without corticosteroid treatment at the time of the start of study treatment;
  • The subject has prothrombin time (PT)/INR or partial thromboplastin time (PTT) test ≥ 1.3 x the laboratory ULN within 7 days before the first dose of study treatment;
  • Concomitant anticoagulation with oral anticoagulants (e.g., warfarin, direct thrombin and Factor Xa inhibitors) or platelet inhibitors (e.g., clopidogrel). Allowed anticoagulants are the following:

    1. Low-dose aspirin for cardioprotection (per local applicable guidelines) is permitted.
    2. Low-dose low molecular weight heparins (LMWH) are permitted.
    3. Anticoagulation with therapeutic doses of LMWH is allowed in subjects without known brain metastases who are on a stable dose of LMWH for at least 6 weeks before first dose of study treatment, and who have had no clinically significant hemorrhagic complications from the anticoagulation regimen or the tumor.
  • The subject has experienced any of the following:

    1. clinically-significant GI bleeding within 6 months before the first dose of study treatment;
    2. hemoptysis of ≥ 0.5 teaspoon (2.5ml) of red blood within 3 months before the first dose of study treatment;
  • any other signs indicative of pulmonary hemorrhage within 3 months before the first dose of study treatment. Clinically significant hematuria, hematemesis, or hemoptysis of > 0.5 teaspoon (2.5 ml) of red blood, or other history of significant bleeding (e.g., pulmonary hemorrhage) within 12 weeks before first dose.
  • The subject has radiographic evidence of cavitating pulmonary lesion(s);
  • The subject has tumor invading or encasing any major blood vessels;
  • The subject has evidence of tumor invading the GI tract (esophagus, stomach, small or large bowel, rectum or anus), or any evidence of endotracheal or endobronchial tumor within 28 days before the first dose of cabozantinib;
  • The subject has uncontrolled, significant intercurrent or recent illness including, but not limited to, the following conditions:

    a. Cardiovascular disorders including: i. Congestive heart failure (CHF): New York Heart Association (NYHA) Class III (moderate) or Class IV (severe) at the time of screening; ii. Concurrent uncontrolled hypertension defined as sustained blood pressure (BP) > 150 mm Hg systolic or > 100 mm Hg diastolic despite optimal antihypertensive treatment within 7 days of the first dose of study treatment; iii. Any history of congenital long QT syndrome; iv. Any of the following within 6 months before the first dose of study

    • treatment: unstable angina pectoris;
    • clinically-significant cardiac arrhythmias;
    • stroke (including transient ischemic attack (TIA), or other ischemic event);
    • myocardial infarction;
    • thromboembolic event requiring therapeutic anticoagulation (Note: subjects with a venous filter (e.g., vena cava filter) are not eligible for this study).
  • GI disorders particularly those associated with a high risk of perforation or fistula formation including: i. Tumors invading the GI tract, active peptic ulcer disease, inflammatory bowel disease (e.g., Crohn's disease), diverticulitis, cholecystitis, symptomatic cholangitis or appendicitis, acute pancreatitis or acute obstruction of the pancreatic duct or common bile duct, or gastric outlet obstruction. Abdominal fistula, GI perforation, bowel obstruction, intra-abdominal abscess within 6 months before randomization

    • Note: Complete healing of an intra-abdominal abscess must be confirmed prior to randomization ii.

ii. No pre-existing fistula of the head and neck. No pre-existing osteonecrosis of the jaw.

  • Other clinically significant disorders that would preclude safe study participation;
  • Major surgery (e.g., GI surgery, removal or biopsy of brain metastasis) within 8 weeks before first dose of study treatment. Complete wound healing from major surgery must have occurred 1 month before first dose and from minor surgery (e.g., simple excision, tooth extraction) at least 10 days before first dose. Subjects with clinically relevant ongoing complications from prior surgery are not eligible.
  • QTcF > 500 msec within 1 month before the first dose of study treatment:

    a. Three ECGs must be performed for eligibility determination. If the average of these three consecutive results for QTcF is ≤ 500 msec, the subject meets eligibility in this regard.

  • Pregnant or lactating females;
  • Inability to swallow intact tablets;
  • Previously identified allergy or hypersensitivity to components of the study treatment formulations;
  • The subject requires chronic concomitant treatment with strong CYP3A4 inducers (e.g., phenytoin, carbamazepine, rifampin, rifabutin, rifapentine, phenobarbital, and St.

John's Wort).

  • Other clinically significant disorders that would preclude safe study participation.

    1. Serious non-healing wound/ulcer/bone fracture.
    2. Uncompensated/symptomatic hypothyroidism.
    3. Moderate to severe hepatic impairment (Child-Pugh B or C).

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03667482


Contacts
Contact: Loren Michel, MD 848-225-6113 michell@mskcc.org
Contact: Eric Sherman, MD 646-888-4234

Locations
United States, New Jersey
Memoral Sloan Kettering Basking Ridge Recruiting
Basking Ridge, New Jersey, United States, 07920
Contact: Loren Michel, MD    848-225-6113      
Contact: Eric Sherman, MD    646-888-4234      
Memoral Sloan Kettering Monmouth Recruiting
Middletown, New Jersey, United States, 07748
Contact: Loren Michel, MD    848-225-6113      
United States, New York
Memorial Sloan Kettering Commack Recruiting
Commack, New York, United States, 11725
Contact: Loren Michel, MD    848-225-6113      
Memorial Sloan Kettering Westchester Recruiting
Harrison, New York, United States, 10604
Contact: Loren Michel, MD    848-225-6113      
Memorial Sloan Kettering Cancer Center Recruiting
New York, New York, United States, 10065
Contact: Loren Michel, MD    848-225-6113      
Contact: Eric Sherman, MD    646-888-4234      
Principal Investigator: Loren Michel, MD         
Memorial Sloan Kettering Rockville Centre Recruiting
Rockville Centre, New York, United States, 11570
Contact: Loren Michel, MD    848-225-6113      
Sponsors and Collaborators
Memorial Sloan Kettering Cancer Center
Investigators
Principal Investigator: Loren Michel, MD Memorial Sloan Kettering Cancer Center

Additional Information:
Responsible Party: Memorial Sloan Kettering Cancer Center
ClinicalTrials.gov Identifier: NCT03667482     History of Changes
Other Study ID Numbers: 18-303
First Posted: September 12, 2018    Key Record Dates
Last Update Posted: November 1, 2018
Last Verified: October 2018

Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No

Keywords provided by Memorial Sloan Kettering Cancer Center:
Cabozantinib
Cetuximab
18-303

Additional relevant MeSH terms:
Neoplasms, Squamous Cell
Carcinoma, Squamous Cell
Neoplasms, Glandular and Epithelial
Neoplasms by Histologic Type
Neoplasms
Carcinoma
Cetuximab
Antineoplastic Agents