This phase I trial is studying the side effects and best dose of sunitinib when given together with cetuximab and radiation therapy in treating patients with locally advanced or recurrent squamous cell carcinoma of the head and neck. 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. Monoclonal antibodies, such as cetuximab, can block tumor growth in different ways. Some block the ability of tumor cells to grow and spread. Others find tumor cells and help kill them or carry tumor-killing substances to them. Radiation therapy uses high-energy x-rays to kill tumor cells. Giving sunitinib together with cetuximab and radiation therapy may kill more tumor cells.
PRIMARY OBJECTIVES: I. To assess the safety, the maximum tolerated dose, and the dose limiting toxicity of sunitinib malate when administered in combination with cetuximab and radiotherapy in patients with locally advanced, recurrent, or second primary poor prognosis, high-risk squamous cell carcinoma of the head and neck. SECONDARY OBJECTIVES: I. To describe the toxicity profile of this regimen. II. To explore the tolerability and feasibility of sunitinib malate when administered in combination with cetuximab and radiotherapy in these patients. III. To assess the best overall response rate (complete and partial response) after completion of treatment. IV. To assess the locoregional control rate. V. To assess the distant control rate. VI. To assess the pharmacokinetics of sunitinib malate delivered by percutaneous gastrostomy tube. OUTLINE: This is a dose-escalation study of sunitinib malate. Patients receive sunitinib malate orally or by percutaneous gastrostomy tube once daily, cetuximab IV over 60-120 minutes once weekly, and undergo concurrent radiotherapy once or twice daily, 5 days a week, for 7-9 weeks in the absence of disease progression or unacceptable toxicity. Patients with persistent disease undergo surgical resection. \*NOTE: \*Patients may have resection prior to enrollment on protocol provided they have high-risk features for recurrence. Some patients undergo blood sample collection at baseline and periodically during study for pharmacokinetic analysis of sunitinib malate and metabolites. After completion of study treatment, patients are followed up periodically for up to 6 years.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
36
Given orally or by percutaneous gastrostomy tube
Correlative studies
Undergo radiotherapy
Given IV
University of Chicago Comprehensive Cancer Center
Chicago, Illinois, United States
Decatur Memorial Hospital
Decatur, Illinois, United States
Evanston CCOP-NorthShore University HealthSystem
Evanston, Illinois, United States
Ingalls Memorial Hospital
Harvey, Illinois, United States
Loyola University Medical Center
Maywood, Illinois, United States
Illinois CancerCare-Peoria
Peoria, Illinois, United States
Central Illinois Hematology Oncology Center
Springfield, Illinois, United States
Fort Wayne Medical Oncology and Hematology Inc - State Boulevard
Fort Wayne, Indiana, United States
University of Maryland Greenebaum Cancer Center
Baltimore, Maryland, United States
University of Michigan University Hospital
Ann Arbor, Michigan, United States
...and 2 more locations
Maximum-tolerated dose (MTD) of sunitinib malate
MTD is defined as the dose level immediately below the non-tolerated dose. The study will utilize a standard "3+3" design to determine the MTD. Dose limiting toxicities (DLTs) used for determining escalation of dose will be those occurring within the period of radiotherapy. Toxicity will be summarized by type and severity using the National Cancer Institute (NCI) Common Terminology Criteria.
Time frame: Up to 7-9 weeks
Objective tumor response rates
Response will be evaluated in this study using the new international criteria proposed by the Response Evaluation Criteria in Solid Tumors (RECIST) Committee. The efficacy analysis population (an exploratory analysis of those patients on study for the MTD) will consist of all subjects who received at least 1 dose of sunitinib. Ninety percent confidence intervals using the exact binomial distribution will be presented. Kaplan-Meier product limit curves will be calculated.
Time frame: From the start of the treatment to up to 6 years
Locoregional control rates
Ninety percent confidence intervals using the exact binomial distribution will be presented. Kaplan-Meier product limit curves will be calculated.
Time frame: Up to 6 years
Disease control rates
Ninety percent confidence intervals using the exact binomial distribution will be presented. Kaplan-Meier product limit curves will be calculated.
Time frame: Up to 6 years
Locoregional recurrence rates
Ninety percent confidence intervals using the exact binomial distribution will be presented. Kaplan-Meier product limit curves will be calculated.
Time frame: At 3 years
Time to progression
Time to progression using Kaplan-Meier product limit curves will be calculated.
Time frame: From the date of registration to the date of progressive disease or death from any cause
Overall survival time
Overall survival using Kaplan-Meier product limit curves will be calculated.
Time frame: From the date of registration to the date of death or date of last patient contact if censored
Pharmacokinetics of sunitinib malate delivered by percutaneous gastrostomy tube
Time frame: Prior to and up to 24 hours after the start of sunitinib malate
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