Study of Pralatrexate With Vitamin B12 and Folic Acid Supplementation for Previously Treated Recurrent or Metastatic Head and Neck Squamous Cell Cancer (HNSCC)
Condition: Head and Neck Cancer
MeSH terms: Neoplasms, Squamous Cell; Carcinoma, Squamous Cell
Intervention: Pralatrexate With Vitamin B12 and Folic Acid
Intervention description: Patients will be treated with 30 mg/m2 of pralatrexate intravenously once weekly for 3 weeks in a 4 week cycle with vitamin supplementation. Patients will take 1.0-1.25 mg oral folic acid on a daily basis. Folic acid should be initiated during the 10-day period preceding the first dose of pralatrexate and dosing will be continued during the full course of therapy and for 30 days after the last dose of pralatrexate. Patients will also receive a vitamin B12 (1 mg) intramuscular injection no more than 10 weeks prior to the first dose of pralatrexate and every 8-10 weeks thereafter. Subsequent vitamin B12 injections may be given the same day as treatment with pralatrexate.
Intervention MeSH terms: Folic Acid; Vitamin B 12; Hydroxocobalamin
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 13.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No
Keywords: Pralatrexate; Vitamin B12; Folic Acid; 10-112

Summary:

      The purpose of this study is to find out if the experimental drug pralatrexate with the
      vitamins folic acid and vitamin B12 might be an effective treatment for head and neck cancer.
      The reason we are doing this study is because another drug called methotrexate has been used
      for a long time to treat head and neck cancer patients. Pralatrexate was designed by
      scientists to be a new drug that works better than methotrexate. Laboratory studies have
      shown that pralatrexate works better than methotrexate at killing cancer cells.

      Pralatrexate has already been studied in patients with other types of cancers, such as
      lymphoma and lung cancer. The results from those studies were promising. Pralatrexate was
      recently approved by the Food and Drug Administration (FDA) as a new treatment for a cancer
      called peripheral T cell lymphoma.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Patients must have histopathologically confirmed recurrent and/or metastatic squamous
             cell carcinoma of the head and neck, including unknown primary squamous cell
             carcinomas of the neck. Confirmation of biopsy/diagnosis will be performed at MSKCC or
             at participating sites (NYU Cancer Institute/NYU Medical Center/ Bellevue Hospital
             Center).

          -  Patients must be at least 18 years of age.

          -  ECOG performance status must be ≥ 0 or 1.

          -  Disease must be measurable by RECIST version 1.1 criteria.

          -  Patients must have been previously treated with systemic chemotherapy (i.e.,
             chemotherapy and/or targeted therapies such as cetuximab for recurrent/metastatic
             HNSCC,.

          -  At least four weeks must have elapsed from previous radiation therapy. Patients must
             have recovered from the acute toxic effects of treatment prior to study enrollment.

          -  Patients must have adequate organ function, as follows:

        Adequate bone marrow reserve: absolute neutrophil count (ANC) > 1,000 cells/mm3, platelets
        > 100,000 cells/mm3, and hemoglobin > 9 g/dL Hepatic: AST and ALT ≤ 3 X upper limit of
        normal (ULN); AST and ALT ≤ 5 X ULN if liver metastasis present; Total bilirubin ≤ 1.5 x
        ULN unless Gilbert's disease is present Renal: Serum creatinine ≤ 1.5 mg/dL or creatinine
        clearance (by either 24 hour urine collection or Cockcroft-Gault equation) > or = to 55
        ml/min

          -  Both women and men and members of all races and ethnic groups are eligible for this
             trial.

          -  Women of childbearing potential must have a negative serum pregnancy test within 14
             days of treatment. Both men and women must agree to use a reliable method of birth
             control until 30 days following the last dose of study drug.

        Exclusion Criteria:

          -  History of any brain metastases unless resected with no evidence for > 12 weeks and
             not on steroids

          -  Women who are lactating

          -  Other active malignancy, other than indolent malignancies which the investigator
             determines are unlikely to interfere with treatment and safety analysis

          -  Patients who have undergone an allogeneic stem cell transplant