Sunitinib in Treating Patients With Recurrent and/or Metastatic Head and Neck Cancer
Condition: Metastatic Squamous Neck Cancer With Occult Primary Squamous Cell Carcinoma; Recurrent Metastatic Squamous Neck Cancer With Occult Primary; Recurrent Squamous Cell Carcinoma of the Hypopharynx; Recurrent Squamous Cell Carcinoma of the Larynx; Recurrent Squamous Cell Carcinoma of the Lip and Oral Cavity; Recurrent Squamous Cell Carcinoma of the Nasopharynx; Recurrent Squamous Cell Carcinoma of the Oropharynx; Recurrent Squamous Cell Carcinoma of the Paranasal Sinus and Nasal Cavity; Stage IV Squamous Cell Carcinoma of the Hypopharynx; Stage IV Squamous Cell Carcinoma of the Larynx; Stage IV Squamous Cell Carcinoma of the Lip and Oral Cavity; Stage IV Squamous Cell Carcinoma of the Nasopharynx; Stage IV Squamous Cell Carcinoma of the Oropharynx; Stage IV Squamous Cell Carcinoma of the Paranasal Sinus and Nasal Cavity
MeSH terms: Carcinoma; Carcinoma, Squamous Cell; Head and Neck Neoplasms; Laryngeal Neoplasms; Oropharyngeal Neoplasms; Squamous Cell Carcinoma of Head and Neck; Nasopharyngeal Carcinoma; Paranasal Sinus Neoplasms; Neoplasms, Unknown Primary; Laryngeal Diseases; Recurrence
Intervention: sunitinib malate
Intervention description: Given orally
Intervention MeSH terms: Sunitinib
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 22.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No

Summary:

      This phase II trial is studying how well sunitinib works in treating patients with recurrent
      and/or metastatic head and neck cancer. Sunitinib may stop the growth of tumor cells by
      blocking some of the enzymes needed for cell growth and by blocking blood flow to the tumor.
    

Eligibility criteria:

        Criteria:

          -  Hemoglobin >= 9 g/dL

          -  Histologically or cytologically confirmed squamous cell carcinoma of the head and
             neck:

               -  Recurrent and/or metastatic disease

          -  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

          -  No known brain metastases

          -  Life expectancy >= 2 months

          -  ECOG performance status (PS) 0-1 or Karnofsky PS 70-100% (for patients in cohort A)

          -  ECOG PS 2 or Karnofsky PS 60-70% (for patients in cohort B)

          -  WBC >= 3,000/mm^3

          -  Absolute neutrophil count >= 1,500/mm^3

          -  Platelet count >= 100,000/mm^3

          -  Calcium =< 12.0 mg/dL

          -  Bilirubin normal

          -  AST and ALT =< 2.5 times upper limit of normal

          -  Creatinine normal OR creatinine clearance >= 60 mL/min

          -  QTc < 500 msec

          -  No New York Heart Association class III or IV heart failure:

               -  Patients with the following are eligible provided they have New York Heart
                  Association class II cardiac function on baseline ECHO/MUGA:

                    -  History of class II heart failure and asymptomatic on treatment

                    -  Prior anthracycline exposure

                    -  Prior central thoracic radiation that included the heart in the radiotherapy
                       port

          -  Not pregnant or nursing

          -  Negative pregnancy test

          -  Fertile patients must use effective contraception

          -  No history of allergic reactions to compounds of similar chemical or biological
             composition to sunitinib malate

          -  No history of serious ventricular arrhythmia (i.e., ventricular fibrillation or
             ventricular tachycardia >= 3 beats in a row)

          -  No history of other significant ECG abnormalities

          -  No uncontrolled hypertension (defined as systolic blood pressure [BP] >= 140 mm Hg or
             diastolic BP >= 90 mm Hg)

          -  No condition resulting in an inability to take oral medication, including any of the
             following:

               -  Gastrointestinal tract disease resulting in an inability to take oral medication
                  or a requirement for IV alimentation

               -  Active peptic ulcer disease

          -  No gastrostomy, jejunostomy, or other forms of enteral tube-feeding modalities

          -  No serious or nonhealing wound, ulcer, or bone fracture

          -  No abdominal fistula, gastrointestinal perforation, or intra-abdominal abscess within
             the past 28 days

          -  No cerebrovascular accident or transient ischemic attack within the past 12 months

          -  No myocardial infarction, cardiac arrhythmia, stable/unstable angina, symptomatic
             congestive heart failure, or coronary/peripheral artery bypass graft or stenting
             within the past 12 months

          -  No pulmonary embolism within the past 12 months

          -  No pre-existing uncontrolled thyroid abnormality (i.e., inability to maintain thyroid
             function within the normal range with medication)

          -  No uncontrolled intercurrent illness, including either of the following:

               -  Ongoing or active infection

               -  Psychiatric illness or social situation that would limit compliance with study
                  requirement

          -  No more than two prior regimens for recurrent or metastatic disease:

               -  Prior chemotherapy as part of initial curative intent therapy (e.g., neoadjuvant,
                  adjuvant, or concurrent chemoradiotherapy) is allowed and will not count as prior
                  therapy for recurrent or metastatic disease

          -  At least 4 weeks since prior major surgery

          -  At least 4 weeks since prior chemotherapy (6 weeks for nitrosoureas or mitomycin C)
             and recovered

          -  At least 4 weeks since prior radiotherapy

          -  No prior treatment with any other antiangiogenic agent (e.g., bevacizumab, sorafenib,
             pazopanib, AZD2171, vatalanib, or VEGF Trap)

          -  No prior surgical procedure affecting absorption

          -  At least 7 days since prior and no concurrent use of CYP3A4 inhibitors, including any
             of the following:

               -  Azole antifungals (e.g., ketoconazole, itraconazole)

               -  Verapamil

               -  Clarithromycin

               -  HIV protease inhibitors (e.g., indinavir, saquinavir, ritonavir, atazanavir,
                  nelfinavir)

               -  Erythromycin

               -  Delavirdine

               -  Diltiazem

          -  At least 12 days since prior and no concurrent CYP3A4 inducers, including any of the
             following:

               -  Rifampin

               -  Phenytoin

               -  Rifabutin

               -  Hypericum perforatum (St. John's wort)

               -  Carbamazepine

               -  Efavirenz

               -  Phenobarbital

               -  Tipranavir

          -  No concurrent therapeutic doses of coumarin-derivative anticoagulants (e.g.,
             warfarin):

        Concurrent dosing of =< 2 mg of warfarin daily for prophylaxis of thrombosis is allowed;
        Concurrent low molecular weight heparin allowed provided prothrombin time INR is =< 1.5

          -  No other concurrent investigational agents

          -  No concurrent agents with proarrhythmic potential, including any of the following:

               -  Terfenadine

               -  Quinidine

               -  Procainamide

               -  Disopyramide

               -  Sotalol

               -  Probucol

               -  Bepridil

               -  Haloperidol

               -  Risperidone

               -  Indapamide

               -  Flecainide

          -  No other concurrent anticancer agents or therapies

          -  No concurrent combination antiretroviral therapy for HIV-positive patients