Trial of Afatinib (BIBW 2992) + Cetuximab in Advanced Solid Tumours
Condition: Neoplasms
Intervention: Cetuximab( erbitux®); Afatinib
Intervention description: once per week; once per day
Intervention MeSH terms: Cetuximab; Afatinib
Phase: Phase 1
Study type: Interventional
Primary purpose: Treatment
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 58.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No

Summary:

      The trial is divided in two parts, Part A and Part B. Part A will involve dose-finding of
      dose-limiting toxicity (DLT) and MTD in patients with advanced solid tumours. Part B will
      involve expansion of the MTD to 3 cohorts including non-small cell lung cancer squamous
      histology, recurrent/ metastatic squamous cell carcinoma of head and neck and other advanced
      solid tumours (except sarcomas).
    

Eligibility criteria:

        Inclusion criteria:

        Part A only

          1. Patients must have advanced malignant solid tumours that are metastatic or
             unresectable

          2. At least one measurable or evaluable (non-measurable) lesion per RECIST 1.1 Part B
             only

          3. Patients must have:

               1. measurable disease per RECIST 1.1

               2. diagnosis of one of the following

                    -  Advanced Non-Small Cell Lung Cancer -Squamous Histology (NSCLC-SQ) with no
                       more than 2 lines of chemotherapy for advanced/metastatic disease ( prior
                       EGFR directed treatment is permitted) or

                    -  Recurrent/Metastatic Squamous Cell Carcinoma of Head and Neck (R/M SCCHN) no
                       more than 2 lines of chemotherapy for advanced disease and no more than 1
                       line of prior cetuximab permitted.

             or

               -  Other malignant solid tumours except sarcomas (for metastatic colorectal cancer,
                  only wild type KRAS are permitted) Part A and B

          4. Age 18 years or older

          5. Written informed consent that is consistent with ICH-GCP guidelines and local law.

          6. Histological/Cytological confirmed diagnosis of malignant solid tumours (exclusion of
             sarcomas)

          7. Advanced disease for whom standard treatment is ineffective or no longer effective

          8. Recovered from previous therapy related AE to </= Grade 1 at the study entry (except,
             for stable sensory neuropathy </= Grade 2 and alopecia)

          9. Eastern Cooperative Oncology Group (ECOG) performance score 0 or 1.

         10. Adequate organ function as defined by the following criteria:

               -  LVEF >50% or within institutional values

               -  Absolute neutrophil count (ANC) >1500/ mm3

               -  Platelet count >75.000/ mm3

               -  Estimated creatinine clearance > 45ml/ min

               -  Total bilirubin<1.5 times upper limit of institutional normal

               -  Aspartate amino transferase (AST) or alanine amino transferase (ALT) <3 x upper
                  limit of institutional normal (ULN) (if related to liver metastases< 5xULN)

        Exclusion criteria:

          1. Chemotherapy, biological therapy or investigational agents within 4 weeks prior to the
             start of study treatment.

          2. Hormonal anti-cancer treatment within 2 weeks prior to the start of study treatment
             (continued use of anti-androgens and/or gonadorelin analogues [LHRH] is permitted)

          3. Radiotherapy within 4 weeks prior to the start of study treatment, except as follows:

               1. Palliative radiation to target organs other than chest may be allowed up to 2
                  weeks prior to study treatment, and

               2. Single dose palliative treatment for symptomatic metastasis outside above
                  allowance to be discussed with sponsor prior to enrolling.

          4. Major surgery (as judged by the investigator) within 4 weeks before starting study
             treatment or scheduled for surgery during the projected course of the study

          5. Known hypersensitivity to afatinib or the excipients of any of the trial drugs

          6. History or presence of clinically relevant cardiovascular abnormalities such as
             uncontrolled hypertension, congestive heart failure NYHA classification of 3, unstable
             angina or poorly controlled arrhythmia as determined by the investigator. Myocardial
             infarction within 6 months prior start treatment.

          7. Female patients of childbearing potential who:

               1. are nursing or

               2. are pregnant or

               3. are not using an acceptable method of birth control or do not plan to continue
                  using this method throughout the study and/or do not agree to submit to pregnancy
                  testing required by this protocol.

          8. Any history of or concomitant condition that, in the opinion of the Investigator,
             would compromise the patient's ability to comply with the study or interfere with the
             evaluation of the efficacy and safety of the test drug

          9. Previous or concomitant malignancies at other sites, except effectively treated
             non-melanoma skin cancers, carcinoma in situ of the cervix, ductal carcinoma in situ
             or effectively treated malignancy that has been in remission for more than 3 years and
             is considered to be cured.

         10. Requiring treatment with any of the prohibited concomitant medications listed in the
             protocol that can not be stopped for the duration of trial participation

         11. Known pre-existing interstitial lung disease

         12. Any history or presence of poorly controlled gastrointestinal disorders that could
             affect the absorption of the study drug (e.g. Crohn's disease, ulcerative colitis,
             chronic diarrhea, malabsorption)

         13. Active hepatitis B infection (defined as presence of HepB sAg and/ or Hep B DNA),
             active hepatitis C infection (defined as presence of Hep C RNA) and/or known HIV
             carrier.

         14. Prior participation in an afatinib clinical study, even if not assigned to afatinib
             treatment.

         15. Meningeal carcinomatosis

         16. Patients with brain or subdural metastases are not eligible, unless they have
             completed local therapy and have discontinued the use of corticosteroids or have been
             on stable dose of corticosteroids for at least 4 weeks before starting study
             treatment. Any symptoms attributed to brain metastases must be stable for at least 4
             weeks before starting study treatment.

         17. Any SPC listed contra-indications for cetuximab

         18. Use of alcohol or drugs incompatible with patient participation in the study in the
             investigator's opinion.