Conditions: Recurrent Skin Cancer Squamous Cell Carcinoma of the Skin
Keywords: squamous cell carcinoma of the skin recurrent skin cancer non-melanomatous skin cancer Radiation ZD1839 Iressa Gefitinib
Allocation: NON_RANDOMIZED | Intervention model: SINGLE_GROUP
Enrollment: 23
Healthy volunteers: no

Brief summary:
The goal of this clinical research study is to learn if giving Iressa (Gefitinib or ZD1839) with surgery and/or radiation will help to control squamous cell carcinoma of the skin. The safety of this treatment will also be studied

Detailed description:
PRIMARY OBJECTIVES:

I. Early progression rate (progression during ZD1839 induction).

II. Feasibility of induction ZD1839 (for all patients) and concomitant ZD1839 with radiotherapy (for unresectable patients).

III. Toxicities of induction ZD1839 (for all patients) and concomitant ZD1839 with radiotherapy (for unresectable patients).

SECONDARY OBJECTIVES:

I. Response: clinical responses to induction therapy.

II. Failures: frequency and timing of local and distant failures.

III. Biomarkers: biomarker levels in tumor and normal tissue.

TERTIARY OBJECTIVES:

I. For progressive disease responders, patients will be followed for locoregional and distant metastases data.

II. Feasibility of maintenance ZD1839.

III. Toxicities of maintenance ZD1839.

OUTLINE: Patients are assigned to 1 of 2 groups.

STRATUM I (initially resectable tumor): Patients undergo radiotherapy once daily (QD) 5 days a week for approximately 6-7 weeks. Patients also receive gefitinib orally (PO) QD for up to 12 months

STRATUM II (initially unresectable tumor): Patients undergo radiotherapy QD 5 days a week for approximately 6-7 weeks. Patients also receive concurrent gefitinib PO QD for 6-7 weeks. Patients then undergo surgery. After surgery, patients receive gefitinib PO QD for up to 12 months.

After completion of study treatment, patients are followed up for up to 5 years.

Arms:
arm 1: Resectable Strata: Induction Gefitinib (60 days), Surgery followed 3-6 weeks later by daily Radiotherapy 5 days a week for approximately 6-7 weeks then after 4 weeks restart Maintenance Gefitinib for up to additional 12 months post radiation.

Gefitinib Induction Phase starting dose 250 mg/day, possible doubling to 500 mg/day for no response Day 15; Maintenance dose post radiation starts at same dose level as last dosing of Induction Phase. arm 2: Unresectable Strata: Concomitant Radiation/Gefitinib and post-radiation (or post-surgery if surgery is indicated) Gefitinib. Daily Radiotherapy 5 days a week for approximately 6-7 weeks concurrent with Maintenance Gefitinib dose daily up to 12 months.

Gefitinib Induction Phase starting dose 250 mg/day, possible doubling to 500 mg/day for no response Day 15; Maintenance dose post radiation starts at same dose level as last dosing of Induction Phase.

Interventions: intervention 1: Gefitinib intervention 2: Radiotherapy intervention 3: Conventional surgery intervention 4: laboratory biomarker analysis
Intervention descriptions: intervention 1: Oral Gefitinib induction therapy given daily for 2 months at 250 mg/day, once a day for 30 days (1 cycle = 30 days) with at least 2 cycles of treatment (60 days) given. After 2 months evaluate for clinical response (15 days) and resectability (60 days). If after 15 days with no tumor response, daily dose doubled (500 mg), and discontinuation if tumor progression. intervention 2: Undergo radiation therapy treatments once a day Monday through Friday for about 7 weeks. Each treatment takes about 15 minutes. intervention 3: Undergo surgery intervention 4: Correlative studies

Protocol document: