Patient case: 64-year-old male with head and neck squamous cell carcinoma; genetic feature: CDKN2A

Clinical trial: Docetaxel And Cisplatin With or Without Erlotinib For Metastatic Or Recurrent Squamous Cell Carcinoma Of Head And Neck

Summary: The goal of this clinical research study is to learn if adding Tarcevaâ (Erlotinib, OSI-774) to the combination of docetaxel and cisplatin/carboplatin can help control SCCHN better than chemotherapy alone, in patients with SCCHN that has spread to other parts of the body or has come back after treatment. The safety of this drug combination will also be studied.

Detailed description: The Study Drugs:
  Erlotinib is designed to block the activity of a protein found on the surface of many tumor cells. Blocking the protein may control tumor growth and survival. This may stop tumors from growing.
  Docetaxel is a drug designed to target and destroy cancer cells.
  Cisplatin has a platinum atom at its center. The platinum is supposed to poison the cancer cells, which may cause them to die. It also may stop replication and transcription of the cancer cells' DNA (the genetic material of cells).
  Carboplatin is designed to interfere with the growth of cancer cells by stopping cell division, which may cause the cells to die.
  Study Groups:
  If you are found to be eligible to take part in this study, you will be randomly assigned (as in the flip of a coin) to 1 of 2 study groups. You have an equal chance of being assigned to either group.
  Both groups will receive up to 6 3-week cycles (18 weeks total) of docetaxel and cisplatin or carboplatin, combined with "study tablets." Your treating doctor will decide if you should receive cisplatin or carboplatin. One group's "study tablet" will be erlotinib, while the other group's "study tablet" will be a placebo (a tablet that looks like the study drug but has no active ingredients). Neither you nor the study doctor will know if you are receiving erlotinib or placebo. However, if needed for your safety, the study doctor will be able to find out what you are receiving.
  If the disease does not get worse and you are tolerating the "study tablets" after the end of the combination chemotherapy treatment, you will continue to receive the "study tablet" every day for as long as you are benefiting. This is called the "maintenance" phase of the study.
  Study Drug Administration:
  Cisplatin/Carboplatin and docetaxel will be given by vein once every 3 weeks. Both drugs will be given on Day 1 of every cycle. Docetaxel is given first, over 1 hour. Cisplatin/Carboplatin is given second, over 2 hours.
  Erlotinib (or placebo) will be taken every day by mouth, with a cup (8 ounces) of water. You should take the tablet on an empty stomach, at least 1 hour before or 2 hours after a meal. You should take the tablet at around the same time each day. Your eating habits around the time you take the tablet should stay the same while you are on study. lf you vomit, you should not take another tablet until your next scheduled dose.
  You will continue taking the erlotinib (or placebo) every day for as long as you are benefiting.
  Study Visits:
  Within 7 days before Cycles 2-6:
  -  You will be asked about any side effects you may be experiencing or any drugs you may be taking.
  -  You will have a physical exam, including a measurement of vital signs and weight.
  -  Blood (about 2-3 teaspoons) will be drawn for routine tests.
  -  You will be asked about your current smoking status and tobacco use.
  -  You will be given your next supply of study tablets, and any returned tablets will be counted.
  -  If your doctor thinks it is needed, women who are able to become pregnant will have a blood (about 1 teaspoon) or urine pregnancy test.
  Within 7 days before Cycles 3 and 5:
  -  You will have a CT or MRI scan and chest x-rays to check the status of the disease. If your doctor thinks it is needed, you may have more imaging scans.
  -  You will complete a quality-of-life questionnaire. The questionnaire will take about 15 minutes to complete.
  "Maintenance" Phase:
  Every 21 days:
  -  You will be asked about any side effects you may be experiencing and about any drugs you may be taking.
  -  You will have a physical exam, including a measurement of vital signs and weight.
  -  Blood (about 2-3 teaspoons) will be drawn for routine tests.
  -  You will be asked about your current smoking status and tobacco use.
  -  You will be given your next supply of study tablets, and any returned capsules will be counted.
  If your doctor thinks it is needed, women who are able to become pregnant will have a blood (about 1 teaspoon) or urine pregnancy test.
  Every 6 weeks:
  -  You will have a CT or MRI scan and chest x-rays to check the status of the disease. If your doctor thinks it is needed, you may have more imaging scans.
  -  You will complete a quality-of-life questionnaire. The questionnaire will take about 15 minutes to complete.
  Length of Study:
  You will stay on study for up to 6 cycles of chemotherapy and study tablets (erlotinib or placebo), followed by the "maintenance" phase. You will be taken off study if the disease gets worse or if you have intolerable side effects. You may also stop receiving study drugs or if the doctor thinks it is in your best interest to stop.
  If you leave the study early for any reason, you should try to complete all of the end-of-study testing.
  End-of-Treatment Visit:
  For all patients, the End of Treatment visit will take place about 30 days after the last dose of study drug/placebo. The following tests and procedures will be performed:
  -  You will be asked about any side effects you may be experiencing and about any drugs you may be taking.
  -  You will have a physical exam, including measurement of vital signs.
  -  Blood (about 2-3 teaspoons) will be drawn for routine tests.
  -  If your doctor thinks it is needed, women who are able to become pregnant will have a blood (about 1 teaspoon) or urine pregnancy test.
  Follow-Up Contact:
  After the End-of-Treatment visit, you may be contacted to collect information about disease status, any treatment you have received, and any other side effects you have experienced. You (or your family members or designees) may be contacted by telephone, in writing, by e-mail, or during clinic visits. This information may also be collected by checking your medical record.
  This is an investigational study. Erlotinib is approved by the FDA for treatment of non-small cell lung cancer. Its use in this study is experimental. Docetaxel, cisplatin, and carboplatin are all FDA approved and commercially available.
  Up to 120 patients will take part in this study. All will be enrolled at MD Anderson.

Eligibility: Inclusion Criteria:
  1. Histologically confirmed metastatic or recurrent SCCHN of the oral cavity, oropharynx, hypopharynx or larynx. Metastatic or recurrent lesions of the nasopharynx and sinus are excluded.
  2. Radiologically measurable disease, defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded) as >/= 20 mm with conventional techniques or as >/= 10 mm with spiral CT scan. Measurable lymph nodes are required to be >/= 15 mm in size (short axis diameter).
  3. Age >/= 18 years
  4. ECOG PS </= 2
  5. Adequate bone marrow, hepatic and renal function defined by: ANC >/= 1.5 x 109/L; Platelet count >/= 100 x 109/L; Total bilirubin </= ULN (excluding Gilbert's disease); ALT (SGPT) </= 1.5 x ULN; Alkaline phosphatase </= 2.5 x ULN; Serum creatinine </= 1.5 x ULN.
  6. Patients with reproductive potential (eg, females menopausal for less than 1 year and not surgically sterilized) must practice effective contraceptive measures for the duration of study drug therapy and for at least 30 days after completion of study drug therapy. Female patients of childbearing potential must provide a negative pregnancy test (serum or urine) </= 14 days prior to treatment initiation.
  7. Written informed consent to participate in the study according to the investigational review board (IRB) or independent ethics committee (IEC).
  Exclusion Criteria:
  1. Histology other than squamous cell carcinoma.
  2. Primary sites other than oral cavity, oropharynx, hypopharynx, and larynx.
  3. Prior palliative chemotherapy for metastatic or recurrent disease.
  4. Prior biological therapy for metastatic or recurrent disease within 3 weeks prior to randomization.
  5. Patients with known, untreated brain metastases. Patients with treated (irradiated or resected) brain metastases are eligible if treatment was completed more than 28 days prior to study entry and if clinical neurologic function is stable.
  6. Pre-existing peripheral neuropathy >/= grade 2.
  7. History of poorly controlled gastrointestinal disorders that could affect the absorption of the study drug (eg, Crohn's disease, ulcerative colitis). Patients requiring feeding tubes are permitted.
  8. Other active malignancies requiring chemotherapy treatment within 2 years prior to randomization, except for adequately treated basal cell or squamous cell skin cancer or in situ cervical or breast cancer or superficial, resected melanoma.
  9. Serious underlying medical condition which would impair the ability of the patient to receive protocol treatment, in the opinion of the treating physician.
  10. History of allergic reactions to compounds of similar chemical composition to the study drugs (docetaxel, cisplatin, carboplatin, erlotinib or their excipients), or other drugs formulated with polysorbate 80.
  11. Any concurrent anti-cancer therapy, excluding hormonal therapy for prostate or breast cancer.
  12. Dementia or significantly altered mental status that would prohibit the understanding and giving of informed consent.
  13. Women who are pregnant or breast-feeding and women or men not practicing effective birth control.

Relevance to patient case: not relevant