This is a single-arm, phase II trial to characterize the clinical outcome of standard of care, cetuximab concurrent with radiation, in a special population (head and neck cancer patients who cannot tolerate concurrent chemoradiotherapy due to advanced age, poor performance status or concurrent illness), and to determine if biomarker response to a loading dose of cetuximab is predictive of that outcome.
Primary Objective 1: Determine changes in tumor EGFR, pEGFR, downstream signaling and novel phosphoproteins following a loading dose of cetuximab in patients who are poor candidates for chemoradiation (age =70 years or with significant co-morbidities) and are therefore treated with cetuximab with radiation. Primary Objective 2: Characterize clinical outcomes, including local recurrence, progression-free survival and overall survival in these patients, and correlate these clinical outcomes with the changes in tumor EGFR, pEGFR, downstream signaling, and novel phosphoproteins. Primary Objective 3: Describe the toxicity, in particular mucositis/dysphagia, of this regimen. Secondary Objective 1: Conduct normal mucosa EGFR assessment for comparison with tumor sample. Secondary Objective 2: Correlate HPV presence and titer with p53 status and clinical outcome.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
23
Patients will receive a single dose of cetuximab 400 mg/m (Day 0). On day 7 (+/- 1 day), a repeat biopsy will be performed. Radiation concurrent with weekly cetuximab 250 mg/m.
Within approximately 4 days (after single dose of Cetuximab), definitive radiation will begin (70 Gy in 35 fractions to the gross tumor, 50-60 Gy to subclinical target volumes) concurrent with weekly cetuximab 250 mg/m.
University of Michigan Medical Center
Ann Arbor, Michigan, United States
University of Michigan Veterans Administration Hospital
Ann Arbor, Michigan, United States
Mean Change in Tumor Epidermal Growth Factor Receptor (EGFR)
The ratio (fold change) of tumor EGFR post-loading dose/pre-loading dose of cetuximab. Reported as the mean of fold changes across all participants who had an evaluable tumor sample.
Time frame: At baseline (pre-loading dose) and day 7 post-loading dose
Mean Change in Tumor Phosphorylated EGFR (pEGFR)
The ratio (fold change) of tumor pEGFR post-loading dose/pre-loading dose of cetuximab. Reported as the mean of fold changes across all participants who had an evaluable tumor sample.
Time frame: At baseline (pre-loading dose) and day 7 post-loading dose
Progression Free Survival Rate
Percentage of participants who survived without recurrent disease, from the time of enrollment to 1 and 2 years.
Time frame: At 1 and 2 years
Overall Survival Rate
Percentage of participants alive at 1 and 2 years after enrollment.
Time frame: At 1 and 2 Years
Number of Participants With Treatment Related Toxicities
Toxicities are measured by number of participants who experience one or more types or indicator of toxicity, shown as all grades and grades 3-4. As each participant could have multiple toxicities, the total number of incidents outnumbers the number of participants. Toxicities are graded according to the CTCAE v4.
Time frame: 3 years
Change in Tumor EGFR Level Relative to EGFR in Normal Mucosa
Normal mucosa EGFR was assessed for comparison with EGFR in tumor sample. The fold change in tumor EGFR level at post-loading dose/pre-loading dose of cetuximab, relative to fold change in normal mucosa EGFR level post-loading dose/pre-loading dose of cetuximab was summarized across all participants who had an evaluable tumor sample and normal mucosa sample. The value reported is the ratio of fold change in tumor/fold change in buccal EGFR.
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Time frame: At baseline (pre-loading dose) and day 7 post-loading dose
Change in Tumor pEGFR Level Relative to pEGFR in Normal Mucosa
Normal mucosa pEGFR was assessed for comparison with pEGFR in tumor sample. The fold change in tumor pEGFR level post-loading dose/pre loading dose of cetuximab, relative to fold change in normal mucosa pEGFR level post-loading dose/pre-loading dose of cetuximab was summarized across all participants who had an evaluable tumor sample and normal mucosa sample. The value reported is the ratio of fold change in tumor/fold change in buccal pEGFR.
Time frame: At baseline (pre-loading dose) and day 7 post-loading dose