Clinical trial NCT03887442: Paclitaxel vs Paclitaxel + Cetuximab in Recurrent - Metastatic Head & Neck Carcinoma After Failure of a 1º Chemotherapy
Official title: Phase II, Randomized Clinical Trial to Assess the Efficacy of Paclitaxel vs Paclitaxel + Cetuximab in Subjects With Recurrent and/or Metastatic Squamous Head & Neck Carcinoma After Failure of a 1º Line Chemotherapy EXTREME Type Treatment
Study type: INTERVENTIONAL
Overall status: TERMINATED
Phase: PHASE2
Conditions: Head and Neck Cancer
Keywords: Head and Neck Cancer
Cetuximab
Erbitux
Paclitaxel
Extreme
Metastatic
Recurrent
Lead sponsor: Grupo Español de Tratamiento de Tumores de Cabeza y Cuello
Sponsor class: OTHER
Collaborators: name: Merck Sharp & Dohme LLC
name: Pivotal S.L.
First posted: 2019-03-25
Enrollment: 17
Sex: ALL
Minimum age (years): 18
Maximum age (years): 75
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: Treatment of recurrent and/or metastatic head and neck squamous cell carcinoma (HNSCC) after progression to first line EXTREME-type treatment in patients undergoing maintenance treatment with cetuximab.


Eligibility criteria: Inclusion Criteria:

1. Signed the informed consent
2. Age ≥ 18 and \< 75 y
3. ECOG (Eastern Cooperative Oncology Group)performance status: 0-1
4. Life expectancy of at least 12 weeks
5. Histological or cytological confirmation of head \& neck squamous cell carcinoma with localization in larynx, oropharynx, oral cavity or hypopharynx.
6. Having received at least 2 cycles of EXTREME-type chemotherapy (cisplatin or carboplatin + fluoropyrimidines + cetuximab) and being in maintenance phase with cetuximab because of having reached CR (Complete response), PR (Partial response) or SD (Stable disease) to said treatment
7. At least one measureable lesion by CT scan or MRI
8. Adequate bone marrow, liver and kidney function, according to:

   * Hb (Hemoglobin) ≥ 9.0 g/dl
   * Platelets 100,000/mm3
   * ANC (Absolute Neutrophil Count) ≥ 1,500/mm3
   * Total bilirubin ≤ 2 times the UNL
   * SGPT/ALT and SGOT/AST ≤ 3 x UNL (Upper normal limit)
   * Alkaline phosphatase ≤ 2.5 x UNL
   * Serum creatinine ≤ 1.5 times the ULN or creatinine clearance \> 50 ml/min
9. Adequate nutritional status: weight loss \< 20% in relationship to usual weight or albumin ≥ 35 g/l, in the last 12 w
10. Seric calcium adjusted to albumine lower or equal to 1,25 UNL.
11. Toxicity, due to previous treatment received, resolved to grade 1, before enrolment in the study
12. Women of childbearing potential should have a (-)ve pregnancy test in serum or urine,7 d before randomization. Postmenopausal women should have remained amenorrheic for at least 12 m. Furthermore, all men as well as women who participate in this study should use effective contraceptive methods beginning with the signing of the informed consent form and up to at least 6 m after the completion of the study or of the last dose, whichever occurs first

Exclusion Criteria:

1. Treatment for recurrent and/or metastatic disease other than the EXTREME- type first line (cisplatin or carboplatin + fluoropyrimidines + cetuximab)
2. Non-measurable lesion as only evidence of disease
3. Nasopharyngeal carcinoma
4. Clinical or radiographic evidence of brain metastases
5. Having history of or presenting clinically significant cardiovascular disease, such as, but not limited to, congestive heart failure, ≥ grade II of the NYHA, severe cardiac arrhythmias that require medication, or ≥ grade II peripheral vascular disease. Furthermore, those patients who have suffered myocardial infarction or unstable angina in the year prior to the onset of the study treatment or a recent onset angina in the last 3 m will also be excluded
6. History of or current presence of grade \>1 peripheral neuropathy
7. History of active neurological disease
8. History of uncontrolled convulsive episode
9. Current ≥ 2 grade infection
10. Known infection by HIV or chronic infection by HBV or HBC or presence of uncontrolled and severe intercurrent infections or other severe and uncontrolled concomitant diseases
11. History of uncontrolled diabetes, uncontrolled HBP or hepatic condition.
12. History of pulmonary fibrosis, acute pulmonary damage or interstitial pneumonia
13. Any antineoplastic treatment within the 4 w prior to the randomization period
14. History of another neoplastic disease during the last 5 y, with the exception of cured "in situ" basal cell ca.skin carcinoma, "in situ" ca.bladder, "in situ" ca.cervix and "in situ" ca.prostate
15. Known allergy or suspicion of allergy or hypersensitivity to any component of cetuximab or paclitaxel
16. Previous treatment with monoclonal antibodies or other signal transduction inhibitors or EGFR-targeted treatment (Except for previous treatment with cetuximab)
17. Known drug abuse (exception Alcoholism)
18. Any important and uncontrolled medical, psychological, psychiatric, geographic or social problem that may interfere in the participation of the subject in the study and that does not allow for adequate follow-up and compliance with the protocol and evaluation of the study results
19. Women who are pregnant or in breast-feeding period
20. Use of any investigational new drug within the 4 w prior to randomization

Primary outcomes:
measure: Progression Free Survival (PFS)
timeFrame: Through study completion. The study was prematurely closed at 19 months due to lack of accrual. The primary endopoint was not analyzed.
Secondary outcomes:
measure: Overall Survival
timeFrame: Through study completion. The study was prematurely closed at 19 months due to lack of accrual. The secondary endopoint was not analyzed.
measure: Percentage of Objective Response
timeFrame: Through study completion. The study was prematurely closed at 19 months due to lack of accrual. Neither the primary nor the secondary endopoints were analyzed.
measure: Participants With Adverse Events
timeFrame: The duration of the study (Nineteen months) and until the last patient included completed one year of follow up / died or was lost to FU. Adverse events were registered from study entry until 60 days after receiving the last dose of study drug.
measure: Treatment Compliance
timeFrame: 3 years
Other outcomes:
Locations:
Study officials:
affiliation: Institut Català d´Oncologia-Duran i Reynals
name: Ricard Mesía, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: Hospital Clinic of Barcelona
name: Juan J. Grau, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: University of Salamanca
name: Elvira del Barco, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: Complejo Hospitalario de Navarra
name: Ruth Vera, MD
role: PRINCIPAL_INVESTIGATOR
References: