Adenoid Cystic Carcinoma, Erbitux, and Particle Therapy

NCT01192087 | Unknown Phase 1 DMC

• 1 other identifier: ACCEPT
• Study Type: interventional
• Target: 49
• Locations: 1 country
• Sites: 1

Brief Summary

The ACCEPT (A(denoid) c(ystic) c(arcinoma), E(rbitux, and) p(article) t(herapy))-trial is a prospective, monocentric phase I/II feasibility trial evaluating toxicity and efficacy in the combined treatment of intensity-modulated radiation therapy (IMRT) and carbon ion (C12) boost with the epidermal growth factor receptor (EGFR) antibody cetuximab. The primary objective of the study is to explore the toxicity of the combined modality regimen consisting of heavy ion therapy / IMRT and EGFR antibody immunotherapy, by assessing the rate of patients with mucositis or any other toxicity of severity grade 3 or 4 according to NCI CTCAE V. 4. Secondary endpoints include local control, distant control, overall disease-free survival, overall survival

Conditions

Adenoid Cystic Carcinoma

Keywords

adenoid cystic carcinoma; carbon ion therapy; IMRT (intensity-modulated therapy); radioimmunotherapy; Cetuximab

Outcome Measures

Primary Outcomes (2)

• Number of Participants with acute adverse effects as a Measure of toxicity

  The primary objective is to explore the toxicity of the combined treatment consisting of heavy ion therapy / IMRT and cetuximab by assessing the rate of patients with mucositis or any other toxicity of severity grade 3 or 4 according to NCI CTCAE V. 4. Acute treatment effects will be evaluated 6 weeks and late effects 3 years post completion of treatment

  6 weeks post completion of therapy

• Number of Participants with late adverse effects as a Measure of toxicity

  The primary objective is to explore the toxicity of the combined treatment consisting of heavy ion therapy / IMRT and cetuximab by assessing the rate of patients with mucositis or any other toxicity of severity grade 3 or 4 according to NCI CTCAE V. 4. Acute treatment effects will be evaluated 6 weeks and late effects 3 years post completion of treatment

  3 years post completion of treatment

Secondary Outcomes (4)

• local relapse-free survival

  at 3 years post treatment

• distant relapse-free survival

  at 3 years post treatment

• overall disease-free survival

  at 3 years post treatment

• overall survival

  at 3 years post treatment

Study Arms (1)

Cetuximab arm

EXPERIMENTAL

patients receive weekly cetuximab in combination with IMRT and carbon ion boost

Drug: Cetuximab

Interventions

Cetuximab DRUG

cetuximab initial dose (7 days prior to RT treatment start): 400 mg/m² body surface cetuximab weekly doses (from RT treatment start throughout radiation treatment): 250 mg/m² body surface

Also known as: Cetuximab (Erbitux)

Cetuximab arm

Eligibility Criteria

• Age: 18 Years - 70 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Histologically proven, or surgically resected adenoid-cystic carcinoma of the head and neck and
• macroscopic or microscopic residual tumor (R1/ R2) or
• Tumor stage \>T3/T4 or
• perineural invasion and
• M0 stage
• Written informed consent
• Age between 18 and 70 years
• Karnofsky Index ≥ 70%
• Adequate bone-marrow, liver, and kidney function:
• neutrophils ≥ 1.5 x 109/L,
• thrombocytes ≥ 100 x 109/L,
• haemoglobin ≥ 10.0 g/dL
• bilirubin ≤ 2.0 g/dL
• SGOT, SGPT, AP, gamma-GT ≤ 3 x ULN
• serum creatinine ≤ 1.5 mg/dL

You may not qualify if:

• Prior RT or chemotherapy for tumors of the head and neck
• R0 resection
• M1 (distant metastases)
• prior immunotherapy
• signs of active infection
• other serious illnesses
• Severe or uncontrolled cardiovascular disease (congestive heart failure NYHA III or IV, unstable angina pectoris, history of myocardial infarction within the last twelve months, significant arrhythmias)
• Significant neurologic or psychiatric disorders including dementia or seizures
• Active disseminated intravascular coagulopathies
• Other serious underlying medical conditions prohibiting the patient's participation in the trial according to the judgement of the investigators
• Active participation in another clinical trial within the past 30 days
• Known allergic/ hypersensitivity reactions to non-human proteins
• Women: pregnant (Positive serum/ urine beta-HCG ) or breast-feeding,
• Known drug abuse,
• Other previous malignancy within the past 5 years, with exception of a history of a previous, adequately treated, basal cell carcinoma of the skin or pre-invasive carcinoma of the cervix,

Sponsors & Collaborators

• Heidelberg University: lead
• Dept. of Radiation Oncology, INF 400, 69120 Heidelberg, Germany: collaborator
• University Hospital Heidelberg: collaborator
• Merck KGaA, Darmstadt, Germany: collaborator

Study Sites (1)

Dept. of Radiation Oncology

Heidelberg, 69120, Germany

RECRUITING

Related Publications (28)

• Chen AM, Bucci MK, Weinberg V, Garcia J, Quivey JM, Schechter NR, Phillips TL, Fu KK, Eisele DW. Adenoid cystic carcinoma of the head and neck treated by surgery with or without postoperative radiation therapy: prognostic features of recurrence. Int J Radiat Oncol Biol Phys. 2006 Sep 1;66(1):152-9. doi: 10.1016/j.ijrobp.2006.04.014.

  PMID: 16904520 BACKGROUND

• Munter MW, Schulz-Ertner D, Hof H, Nikoghosyan A, Jensen A, Nill S, Huber P, Debus J. Inverse planned stereotactic intensity modulated radiotherapy (IMRT) in the treatment of incompletely and completely resected adenoid cystic carcinomas of the head and neck: initial clinical results and toxicity of treatment. Radiat Oncol. 2006 Jun 6;1:17. doi: 10.1186/1748-717X-1-17.

  PMID: 16756669 BACKGROUND

• Schulz-Ertner D, Nikoghosyan A, Didinger B, Munter M, Jakel O, Karger CP, Debus J. Therapy strategies for locally advanced adenoid cystic carcinomas using modern radiation therapy techniques. Cancer. 2005 Jul 15;104(2):338-44. doi: 10.1002/cncr.21158.

  PMID: 15937907 BACKGROUND

• Schulz-Ertner D, Nikoghosyan A, Thilmann C, Haberer T, Jakel O, Karger C, Kraft G, Wannenmacher M, Debus J. Results of carbon ion radiotherapy in 152 patients. Int J Radiat Oncol Biol Phys. 2004 Feb 1;58(2):631-40. doi: 10.1016/j.ijrobp.2003.09.041.

  PMID: 14751537 BACKGROUND

• Schulz-Ertner D, Nikoghosyan A, Jakel O, Haberer T, Kraft G, Scholz M, Wannenmacher M, Debus J. Feasibility and toxicity of combined photon and carbon ion radiotherapy for locally advanced adenoid cystic carcinomas. Int J Radiat Oncol Biol Phys. 2003 Jun 1;56(2):391-8. doi: 10.1016/s0360-3016(02)04511-x.

  PMID: 12738314 BACKGROUND

• Jakel O, Kramer M, Schulz-Ertner D, Heeg P, Karger CP, Didinger B, Nikoghosyan A, Debus J. Treatment planning for carbon ion radiotherapy in Germany: review of clinical trials and treatment planning studies. Radiother Oncol. 2004 Dec;73 Suppl 2:S86-91. doi: 10.1016/s0167-8140(04)80022-7.

  PMID: 15971317 BACKGROUND

• Huber PE, Debus J, Latz D, Zierhut D, Bischof M, Wannenmacher M, Engenhart-Cabillic R. Radiotherapy for advanced adenoid cystic carcinoma: neutrons, photons or mixed beam? Radiother Oncol. 2001 May;59(2):161-7. doi: 10.1016/s0167-8140(00)00273-5.

  PMID: 11325445 BACKGROUND

• Douglas JG, Koh WJ, Austin-Seymour M, Laramore GE. Treatment of salivary gland neoplasms with fast neutron radiotherapy. Arch Otolaryngol Head Neck Surg. 2003 Sep;129(9):944-8. doi: 10.1001/archotol.129.9.944.

  PMID: 12975266 BACKGROUND

• Pommier P, Liebsch NJ, Deschler DG, Lin DT, McIntyre JF, Barker FG 2nd, Adams JA, Lopes VV, Varvares M, Loeffler JS, Chan AW. Proton beam radiation therapy for skull base adenoid cystic carcinoma. Arch Otolaryngol Head Neck Surg. 2006 Nov;132(11):1242-9. doi: 10.1001/archotol.132.11.1242.

  PMID: 17116822 BACKGROUND

• Mizoe JE, Tsujii H, Kamada T, Matsuoka Y, Tsuji H, Osaka Y, Hasegawa A, Yamamoto N, Ebihara S, Konno A; Organizing Committee for the Working Group for Head-And-Neck Cancer. Dose escalation study of carbon ion radiotherapy for locally advanced head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2004 Oct 1;60(2):358-64. doi: 10.1016/j.ijrobp.2004.02.067.

  PMID: 15380567 BACKGROUND

• de Haan LD, De Mulder PH, Vermorken JB, Schornagel JH, Vermey A, Verweij J. Cisplatin-based chemotherapy in advanced adenoid cystic carcinoma of the head and neck. Head Neck. 1992 Jul-Aug;14(4):273-7. doi: 10.1002/hed.2880140403.

  PMID: 1381339 BACKGROUND

• Kaplan MJ, Johns ME, Cantrell RW. Chemotherapy for salivary gland cancer. Otolaryngol Head Neck Surg. 1986 Sep;95(2):165-70. doi: 10.1177/019459988609500206.

  PMID: 3035459 BACKGROUND

• Suen JY, Johns ME. Chemotherapy for salivary gland cancer. Laryngoscope. 1982 Mar;92(3):235-9. doi: 10.1288/00005537-198203000-00003.

  PMID: 6279995 BACKGROUND

• Creagan ET, Woods JE, Rubin J, Schaid DJ. Cisplatin-based chemotherapy for neoplasms arising from salivary glands and contiguous structures in the head and neck. Cancer. 1988 Dec 1;62(11):2313-9. doi: 10.1002/1097-0142(19881201)62:113.0.co;2-4.

  PMID: 3179947 BACKGROUND

• Dreyfuss AI, Clark JR, Fallon BG, Posner MR, Norris CM Jr, Miller D. Cyclophosphamide, doxorubicin, and cisplatin combination chemotherapy for advanced carcinomas of salivary gland origin. Cancer. 1987 Dec 15;60(12):2869-72. doi: 10.1002/1097-0142(19871215)60:123.0.co;2-y.

  PMID: 2824016 BACKGROUND

• Venook AP, Tseng A Jr, Meyers FJ, Silverberg I, Boles R, Fu KK, Jacobs CD. Cisplatin, doxorubicin, and 5-fluorouracil chemotherapy for salivary gland malignancies: a pilot study of the Northern California Oncology Group. J Clin Oncol. 1987 Jun;5(6):951-5. doi: 10.1200/JCO.1987.5.6.951.

  PMID: 3585449 BACKGROUND

• Laurie SA, Licitra L. Systemic therapy in the palliative management of advanced salivary gland cancers. J Clin Oncol. 2006 Jun 10;24(17):2673-8. doi: 10.1200/JCO.2005.05.3025.

  PMID: 16763282 BACKGROUND

• Dodd RL, Slevin NJ. Salivary gland adenoid cystic carcinoma: a review of chemotherapy and molecular therapies. Oral Oncol. 2006 Sep;42(8):759-69. doi: 10.1016/j.oraloncology.2006.01.001. Epub 2006 Jun 6.

  PMID: 16757203 BACKGROUND

• Airoldi M, Gabriele AM, Gabriele P, Pedani F, Marchionatti S, Succo G, Beatrice F, Bumma C. Concomitant chemoradiotherapy followed by adjuvant chemotherapy in parotid gland undifferentiated carcinoma. Tumori. 2001 Jan-Feb;87(1):14-7. doi: 10.1177/030089160108700103.

  PMID: 11669550 BACKGROUND

• Haddad RI, Posner MR, Busse PM, Norris CM Jr, Goguen LA, Wirth LJ, Blinder R, Krane JF, Tishler RB. Chemoradiotherapy for adenoid cystic carcinoma: preliminary results of an organ sparing approach. Am J Clin Oncol. 2006 Apr;29(2):153-7. doi: 10.1097/01.coc.0000203756.36866.17.

  PMID: 16601434 BACKGROUND

• Younes MN, Park YW, Yazici YD, Gu M, Santillan AA, Nong X, Kim S, Jasser SA, El-Naggar AK, Myers JN. Concomitant inhibition of epidermal growth factor and vascular endothelial growth factor receptor tyrosine kinases reduces growth and metastasis of human salivary adenoid cystic carcinoma in an orthotopic nude mouse model. Mol Cancer Ther. 2006 Nov;5(11):2696-705. doi: 10.1158/1535-7163.MCT-05-0228.

  PMID: 17121916 BACKGROUND

• Vered M, Braunstein E, Buchner A. Immunohistochemical study of epidermal growth factor receptor in adenoid cystic carcinoma of salivary gland origin. Head Neck. 2002 Jul;24(7):632-6. doi: 10.1002/hed.10104.

  PMID: 12112535 BACKGROUND

• Hotte SJ, Winquist EW, Lamont E, MacKenzie M, Vokes E, Chen EX, Brown S, Pond GR, Murgo A, Siu LL. Imatinib mesylate in patients with adenoid cystic cancers of the salivary glands expressing c-kit: a Princess Margaret Hospital phase II consortium study. J Clin Oncol. 2005 Jan 20;23(3):585-90. doi: 10.1200/JCO.2005.06.125.

  PMID: 15659505 BACKGROUND

• Bonner JA, Harari PM, Giralt J, Azarnia N, Shin DM, Cohen RB, Jones CU, Sur R, Raben D, Jassem J, Ove R, Kies MS, Baselga J, Youssoufian H, Amellal N, Rowinsky EK, Ang KK. Radiotherapy plus cetuximab for squamous-cell carcinoma of the head and neck. N Engl J Med. 2006 Feb 9;354(6):567-78. doi: 10.1056/NEJMoa053422.

  PMID: 16467544 BACKGROUND

• Alcedo JC, Fabrega JM, Arosemena JR, Urrutia A. Imatinib mesylate as treatment for adenoid cystic carcinoma of the salivary glands: report of two successfully treated cases. Head Neck. 2004 Sep;26(9):829-31. doi: 10.1002/hed.20094.

  PMID: 15350030 BACKGROUND

• Therasse P, Arbuck SG, Eisenhauer EA, Wanders J, Kaplan RS, Rubinstein L, Verweij J, Van Glabbeke M, van Oosterom AT, Christian MC, Gwyther SG. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst. 2000 Feb 2;92(3):205-16. doi: 10.1093/jnci/92.3.205.

  PMID: 10655437 BACKGROUND

• Adeberg S, Akbaba S, Lang K, Held T, Verma V, Nikoghosyan A, Bernhardt D, Munter M, Freier K, Plinkert P, Hauswald H, Herfarth K, Rieken S, Debus J, Jensen AD. The Phase 1/2 ACCEPT Trial: Concurrent Cetuximab and Intensity Modulated Radiation Therapy with Carbon Ion Boost for Adenoid Cystic Carcinoma of the Head and Neck. Int J Radiat Oncol Biol Phys. 2020 Jan 1;106(1):167-173. doi: 10.1016/j.ijrobp.2019.09.036. Epub 2019 Oct 3.

  PMID: 31586664 DERIVED

• Jensen AD, Nikoghosyan A, Hinke A, Debus J, Munter MW. Combined treatment of adenoid cystic carcinoma with cetuximab and IMRT plus C12 heavy ion boost: ACCEPT [ACC, Erbitux(R) and particle therapy]. BMC Cancer. 2011 Feb 15;11:70. doi: 10.1186/1471-2407-11-70.

  PMID: 21320355 DERIVED

MeSH Terms

Conditions

Carcinoma, Adenoid Cystic

Interventions

Cetuximab

Condition Hierarchy (Ancestors)

Adenocarcinoma; Carcinoma; Neoplasms, Glandular and Epithelial; Neoplasms by Histologic Type; Neoplasms

Intervention Hierarchy (Ancestors)

Antibodies, Monoclonal, Humanized; Antibodies, Monoclonal; Antibodies; Immunoglobulins; Immunoproteins; Blood Proteins; Proteins; Amino Acids, Peptides, and Proteins; Serum Globulins; Globulins

Study Officials

• Jürgen Debus, Prof. Dr. Dr.

  Dept. of Radiation Oncology, INF 400, 69120 Heidelberg, Germany

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Alexandra D Jensen, MD MSc

CONTACT

+49-6221-56-; alexandra.jensen@med.uni-heidelberg.de

Marc W Münter, MD

CONTACT

+49-6221-56-; marc.muenter@med.uni-heidelberg.de

Study Design

• Study Type: interventional
• Phase: phase 1
• Allocation: NA
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER

Study Record Dates

• First Submitted: August 30, 2010
• First Posted: August 31, 2010
• Study Start: June 1, 2012
• Primary Completion: July 1, 2015
• Study Completion: July 1, 2017
• Last Updated: April 24, 2013

Record last verified: 2013-04

Locations

DE (1)