Cetuximab Compared to Mitomycin-C and 5-Fluorouracil for Locally Advanced Squamous Cell Carcinomas of the Head and Neck

NCT02015650 | Terminated Phase 4

• 2 other identifiers: MITOCET2013-001296-20
• Study Type: interventional
• Target: 4
• Locations: 1 country
• Sites: 1

Brief Summary

Concomitant radio-chemotherapy has become a standard therapy for advanced squamous cell carcinomas of head and neck. Local side effects caused by chemotherapy, like mucositis, increase in combination with radiotherapy. Mucositis, as a painful inflammation and ulceration of the oral mucosa, limits patient´s treatment plan. Studies showed that one third of the patients discontinued Chemotherapy because of the side effects. Accordingly to these side effects, patients eating habits get limited. This requires an increase of pain medication, mostly an opioid derivate, which causes side effects too, which requires other symptomatic medication. This requires a change of nutrition from hard to pappy food and at further impairing, liquid food is needed. A central vein catheter has to be done for parental nutrition and a gastrostomy for enteral nutrition, which means risk of haemorrhage and increased risk of bacteraemias and sepsis for the patient. This would mean a decrease of general condition and a dose reduction or treatment stop is needed. Accordingly, the results are treatment delay and prolongation of hospital stay. Risk of the study will be the known side effects of the products: Mitomycin-C, 5-Fluorouracile, Cetuximab and radiation therapy. These are listed in the particular product description and the description of radiation thera-py. Another risk would be that the primary objective cannot be fulfilled. So the patients would have a lower quality of life than expected. Following benefits are expected. Benefit for patient:

• Decrease of mucositis and side effects caused by mucositis, also xerostomia, taste disturbances, dietary restrictions, dysphagia
• Decrease of pain medication and side effects caused by pain medication
• Decrease of surgical intervention (gastric tube, central venous catheter) and risks caused by the interventions (sepsis, bacteraemia, bleeding, injury of heart and stomach, etc.)
• Improving of patients social functioning, social eating, social contact
• No interruptions of therapy
• Increase of life quality
• Weight stabilization Benefit for clinical practice:
• Increase of compliance
• Fulfilling of complete therapy
• Hospital stays as planned

Conditions

Head and Neck Neoplasms

Keywords

Locally advanced squamous cell carcinomas of head and neck

Outcome Measures

Primary Outcomes (1)

• Quality of Life

  The primary endpoint of the study is to examine the quality of life, based on differences in acute and late side effects.

  3 years

Secondary Outcomes (2)

• Efficacy of Cetuximab plus radiation therapy

  3 years

• Equality in therapy of Cetuximab plus radiation therapy versus Mitomycin C/5-Fluorouracil plus radiation therapy.

  3 years

Study Arms (2)

Cetuximab

ACTIVE COMPARATOR

Patients in treatment group A will receive Cetuximab at a loading dose of 400 mg/m2 (administered over 120 minutes) and weekly maintenance doses of 250 mg/m2 (administered over 60 minutes) in combination with radiation therapy.

Drug: Cetuximab

Mitomycin-C / 5-Fluorouracil

ACTIVE COMPARATOR

Patients in treatment group B will receive 7 weeks of radiation therapy concomitant with Mitomycin-C 10mg/m² (max. 15mg/m²) d 8 and d 43 and 5-Fluorouracil 1000mg/m²/24h (max. 1500mg/m²/24h) d 8 - 12 and d 43 - 47. Radiation therapy will begin on day 8.

Drug: Mitomycin-C/ 5-Fluorouracil

Interventions

Cetuximab DRUG

Patients in treatment group A will receive Cetuximab at a loading dose of 400 mg/m2 (administered over 120 minutes) and weekly maintenance doses of 250 mg/m2 (administered over 60 minutes) in combination with radiation therapy.

Cetuximab

Mitomycin-C/ 5-Fluorouracil DRUG

Patients in treatment group B will receive 7 weeks of radiation therapy concomitant with Mitomycin-C 10mg/m² (max. 15mg/m²) d 8 and d 43 and 5-Fluorouracil 1000mg/m²/24h (max. 1500mg/m²/24h) d 8 - 12 and d 43 - 47. Radiation therapy will begin on day 8.

Mitomycin-C / 5-Fluorouracil

Eligibility Criteria

• Age: 18 Years - 80 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• must have a non-resectable cancer of head and neck
• must have a pathologically proven squamous cell carcinoma arising in the oropharynx, oral cavity, hypopharynx, or larynx or cancer of unknown primary site
• must have a stage III or IV disease with an expected survival time of ≥ 12 months with node status of N0-N2
• must be medically suitable to withstand a course of definitive radiation therapy and concomitant chemotherapy or antibody-therapy
• must have a Karnofsky performance status (KPS) of ≥ 70 at the time of screening
• must be between ≥18 and ≤80 years of age
• must have the following laboratory values:
• Analysis/International System of Units (SI units) Neutrophil count/≥ 1.5 G/l Platelet count/≥ 100 G/l Serum glutamate oxaloacetate transaminase (SGOT)/≤ 2 x the upper limit of normal Serum glutamate pyruvate transaminase (SGPT)/≤ 2 x the upper limit of normal Serum creatinine or estimated creatinine clearance/≤ 1.5mg/dl or Epidermal growth factor receptor (eGFR)≥ 50 ml/min/1.73m² Serum calcium/Within normal limits
• must be disease free from a previously treated malignancy for more than three years
• must provide a signed and dated written informed consent
• Female subject of childbearing potential must:
• Understand that the study medication could have an expected teratogenic risk
• Agree to use, and be able to comply with, effective contraception without interruption, 4 weeks before starting study drug, throughout study drug therapy (including dose interruptions) and for 3 months after the end of study drug therapy, even if she has amenorrhoea. This applies unless the subject commits to absolute and continued abstinence confirmed on a monthly basis. The following are effective methods of contraception\* Implant Levonorgestrel-releasing intrauterine system (IUS) Medroxyprogesterone acetate depot Tubal sterilisation Sexual intercourse with a vasectomised male partner only; vasectomy must be confirmed by two negative semen analyses Ovulation inhibitory progesterone-only pills (i.e., desogestrel)
• \* Combined oral contraceptive pills are not recommended. If a subject was using combined oral contraception, she must switch to one of the methods above. The increased risk of venous thromboembolism (VTE) continues for 4 to 6 weeks after stopping combined oral contraception.
• Agree to have a medically supervised pregnancy test with a minimum sensitivity of 25 milli-International units (mIU)/ml not more than 3 days before the start of study medication once the subject has been on effective contraception for at least 4 weeks. This requirement also applies to women of childbearing potential who practice complete and continued abstinence.

You may not qualify if:

• Evidence of distant metastatic disease
• Prior systemic chemotherapy within the last three years
• Previous surgery for the tumor under study, other than biopsy and debulking of squamous cell carcinoma arising in the larynx
• Prior radiation therapy to the head and neck
• Receiving radiation therapy as part of a postoperative regimen following primary surgical resection
• Pregnancy or breastfeeding
• Patient received prior Cetuximab or murine monoclonal antibody therapy
• Patient received prior Mitomycin-C and 5-Fluorouracil
• Actual hemorrhages
• Stomatitis, ulcerations in the mouth and the gastrointestinal tract
• Actual severe diarrhea
• Severe infectious diseases (Hepatitis A, B, C, D HIV)
• Coagulation disorders
• Active vaccination
• Patient has a medical or psychological condition that would not permit the patient to complete the trial or sign the informed consent

Sponsors & Collaborators

• Medical University Innsbruck: lead

Study Sites (1)

Medical University Innsbruck, Department for Radiooncology and Therapeutic Oncology

Innsbruck, Tyrol, 6020, Austria

Location

MeSH Terms

Conditions

Head and Neck Neoplasms

Interventions

Cetuximab; Mitomycin; Fluorouracil

Condition Hierarchy (Ancestors)

Neoplasms by Site; Neoplasms

Intervention Hierarchy (Ancestors)

Antibodies, Monoclonal, Humanized; Antibodies, Monoclonal; Antibodies; Immunoglobulins; Immunoproteins; Blood Proteins; Proteins; Amino Acids, Peptides, and Proteins; Serum Globulins; Globulins; Mitomycins; Indolequinones; Quinones; Organic Chemicals; Azirines; Heterocyclic Compounds, 1-Ring; Heterocyclic Compounds; Indoles; Heterocyclic Compounds, 2-Ring; Heterocyclic Compounds, Fused-Ring; Uracil; Pyrimidinones; Pyrimidines

Study Design

• Study Type: interventional
• Phase: phase 4
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Prof.Dr.

Study Record Dates

• First Submitted: December 13, 2013
• First Posted: December 19, 2013
• Study Start: April 1, 2014
• Primary Completion: April 19, 2016
• Study Completion: April 19, 2016
• Last Updated: May 18, 2020

Record last verified: 2020-05

Locations

AU (1)