RATIONALE: Monoclonal antibodies, such as cetuximab, can block abnormal cell growth in different ways. Some block the ability of abnormal cells to grow and spread. Others find abnormal cells and help kill them or carry cell-killing substances to them. PURPOSE: This randomized phase II trial is studying how well cetuximab works in treating patients with precancerous lesions of the upper aerodigestive tract.
OBJECTIVES: Primary * To determine the histologic response rate in patients with high-risk, premalignant lesions of the upper aerodigestive tract treated with cetuximab. Secondary * To determine the clinical response rate in these patients. * To determine if patterns of epidermal growth factor receptor (EGFR) component expression are altered in these patients. * To determine the change in status of genetic alterations, including loss of heterozygosity, in these patients. OUTLINE: This is a multicenter study. Patients are stratified by lesion type \[diffuse dysplasia vs recurrent dysplasia vs dysplastic lesions with 3p or 9p loss of heterozygosity (LOH)\]. Patients are randomized to 1 of 2 arms. * Arm I (treatment): Patients receive cetuximab IV over 1-2 hours on days 1, 8, 15, 22, 29, 36, 43, and 50 in the absence of disease progression or unacceptable toxicity. * Arm II (control): Patients receive regular follow-up care. Patients have the option of receiving cetuximab after completion of the study. In both arms, patients with persistent or recurrent high-grade dysplasia or dysplastic lesions with 3p or 9p LOH undergo surgical resection, if feasible, after week 8. Tumor biopsy samples are obtained at baseline\* and after week 8 for histologic and biomarker correlative studies. Tissue samples are analyzed by histopathology to determine histologic changes in post-treatment lesions and by immuno-histochemistry (IHC) to measure expression and activation of EGFR signaling pathway components. LOH studies are also performed. NOTE: \*Paraffin-embedded tissue from the original diagnostic biopsy may be used for baseline assessment, if the diagnostic biopsy was performed within 3 months prior to study entry. After completion of study therapy, patients are followed at approximately 1 month, every 3 months for 2 years, and then every 6 months for up to 5 years as per routine standard of care.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
given IV
UCSF Helen Diller Family Comprehensive Cancer Center
San Francisco, California, United States
University of Chicago Cancer Research Center
Chicago, Illinois, United States
Lucille P. Markey Cancer Center at University of Kentucky
Lexington, Kentucky, United States
Number of Participants With Objective Response Based on Histologic Grade
Histologic downgrade by at least one grade of dysplasia (e.g Severe to Moderate).
Time frame: 8 weeks
Number of Participants With Objective Response Based on Clinical Assessment
Clinical visualization on whether lesion responded to treatment (i.e., direct visualization of the lesion combined with histologic grade)
Time frame: 8 weeks
Status of Epidermal Growth Factor Receptor (EGFR) Pathway Components and Molecular Alterations in Pre-treatment Biopsies
Time frame: Baseline (pre-treatment)
Status of EGFR Pathway Components and Molecular Alterations in Post-treatment Biopsies
Time frame: At 8 weeks post-treatment
Survival
Time frame: Up to year 5 years post-treatment
Lesion Recurrence
Time frame: Up to year 5 years post-treatment
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TREATMENT
Masking
DOUBLE
Enrollment
35
Greenebaum Cancer Center at University of Maryland Medical Center
Baltimore, Maryland, United States
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
Baltimore, Maryland, United States
University of Michigan Comprehensive Cancer Center
Ann Arbor, Michigan, United States
NYU Cancer Institute at New York University Medical Center
New York, New York, United States
UPMC Cancer Centers
Pittsburgh, Pennsylvania, United States
Hollings Cancer Center at Medical University of South Carolina
Charleston, South Carolina, United States
British Columbia Cancer Agency - Vancouver Cancer Centre
Vancouver, British Columbia, Canada