Patient case: 65-year-old female with squamous cell lung cancer; genetic feature: FGFR1 amplification

Clinical trial: GSK1120212 in Surgically Resectable Oral Cavity Squamous Cell Cancer

Summary: This phase II trial studies how trametinib effects tumor cells in patients with oral cavity squamous cell carcinoma that can be removed by surgery. Trametinib may shrink the tumor by blocking an enzyme pathway needed for cell growth.

Detailed description: The rationale for this study in oral cavity squamous cell carcinomas rests on pre-clinical findings demonstrating that (a) activation of the ERK1/2 kinases is associated with aggressive features, (b) this aggressive phenotype is directly linked to expression of CD44, a cell surface hyaluronan receptor and (c) this association between activated ERK1/2 and CD44 is also identified in human cell lines and primary tumors. These data suggest that ERK1/2 is targetable biochemical pathway in CD44 expressing cells. These cells represent putative cancer stem cells or tumor initiating cells that have been associated with worse patient outcomes. Thus, the application of GSK1120212 to target OCSCC is a specific translational application of our laboratory findings.

Eligibility: Inclusion Criteria:
  -  Patient must have histologically or cytologically confirmed oral cavity squamous cell carcinoma of stage 2, 3, 4a, or 4b.
  -  Patients by definition have disease at the primary tumor site of at least 2 centimeters.
  -  Patient's treatment plan must include primary tumor site biopsy followed by gross excision of the primary tumor site at a separate operative procedure.
  -  Patients with concurrent primary head and neck tumors that will be resected as part of treatment plan are considered eligible
  -  Patients with head and neck cancer recurrence requiring surgery with no history of prior chemotherapy or radiation therapy are considered eligible.
  -  Patient must be ≥ 18 years of age.
  -  Patient must have an ECOG performance status ≤ 1
  -  Patient must have normal bone marrow and organ function as defined below:
  -  Absolute neutrophil count ≥1,200/mcl
  -  Hemoglobin ≥9.0 g/dL
  -  Platelets ≥100,000/mcl
  -  PT/INR and PTT ≤1.3 x IULN (Subjects on Coumadin are included if their coagulation is within a normal therapeutic range)
  -  LVEF ≥ILLN (by ECHO or MUGA)
  -  Albumin ≥2.5 g/dL
  -  Total bilirubin ≤1.5 x IULN
  -  AST(SGOT)/ALT(SGPT) ≤2.5 x IULN
  -  Creatinine ≤1.5 x IULN OR Creatinine clearance ≥50 mL/min/1.73 m2 for patients with creatinine levels above institutional normal
  -  Women of childbearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control, intrauterine device, male partner sterilization, or complete abstinence) prior to study entry, for the duration of study participation, and for at least 4 months after the last dose of study treatment. Should a woman become pregnant or suspect she is pregnant while participating in this study, she must inform her treating physician immediately.
  -  Patient must have the ability to swallow and retain orally administered medication.
  -  Patient (or legally authorized representative if applicable) must be able to understand and willing to sign an IRB approved written informed consent document.
  -  Both men and women and members of all races and ethnic groups are eligible for this trial.
  Exclusion Criteria:
  -  Patients must not have had any prior head and neck cancer treatment.
  -  Patient must not have a history of other malignancy ≤ 3 years previous with the exception of previous head and neck cancer treated only by surgery basal cell or squamous cell carcinoma of the skin which were treated with local resection only or carcinoma in situ of the cervix.
  -  Patients must not be receiving any other investigational agents.
  -  Patient must not have a history of retinal vein occlusion (RVO).
  -  Patient must not have known symptomatic leptomeningeal or brain metastases or spinal cord compression.
  -  Patient must not have a history of allergic reactions attributed to compounds of similar chemical or biologic composition to GSK1120212 or other agents used in the study.
  -  Patient must not have any clinically significant gastrointestinal abnormalities that may alter absorption such as malabsorption syndrome or major resection of the stomach or bowels.
  -  Patient must not have an uncontrolled intercurrent illness including, but not limited to, ongoing or active infection symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements.
  -  Patient must not be pregnant and/or breastfeeding.
  -  Patient must not be known to be HIV-positive, hepatitis B-positive, or hepatitis C-positive (with the exception of chronic or cleared HBV or HCV infection, which will be allowed).
  -  Patient must not be taking any herbal supplements during the study (including but not limited to St. John's wort, kava, ephedra (ma huang), gingko biloba, dehydroepiandrosterone (DHEA), yohimbe, saw palmetto, or ginseng). If a potential patient is taking any herbal supplements, s/he must discontinue prior to beginning study treatment.
  -  Patient must not have any history or evidence of cardiovascular risk including any of the following:
  -  QTcB ≥ 480 msec
  -  History or evidence of current clinically significant uncontrolled arrhythmias (exception: subjects with controlled atrial fibrillation for > 30 days prior to registration are eligible)
  -  History of acute coronary syndromes (including myocardial infarction and unstable angina), coronary angioplasty, or stenting within 6 months prior to registration
  -  History or evidence of current ≥ Class II congestive heart failure as defined by New York Heart Association.
  -  Abnormal cardiac valve morphology (≥ grade 2) documented by echocardiogram (subjects with grade 1 abnormalities [i.e., mild regurgitation/stenosis] can be entered on study). Subjects with moderate valvular thickening should not be entered on study.
  -  Treated refractory hypertension defined as a blood pressure of systolic >140 mmHg and/or diastolic >90 mmHg which cannot be controlled by antihypertensive therapy.
  -  Intra-cardiac defibrillator or permanent pacemaker
  -  Cardiac metastases
  -  Patient must not have a history of interstitial lung disease or pneumonitis
  -  Current use of a prohibited medication

Relevance to patient case: not relevant