A Phase II Trial of Induction Chemotherapy Followed by Cetuximab (Erbitux) With Low Dose vs. Standard Dose IMRT in Patients With HPV-Associated Resectable Squamous Cell Carcinoma of the Oropharynx
RATIONALE: Drugs used in chemotherapy, such as paclitaxel and cisplatin, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. 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 paclitaxel, cisplatin, and cetuximab together with radiation therapy may kill more tumor cells. PURPOSE: This phase II trial is studying paclitaxel, cisplatin, and cetuximab to see how well they work when followed by cetuximab and two different doses of intensity-modulated radiation therapy in treating patients with HPV-associated stage III or stage IV cancer of the oropharynx that can be removed by surgery.
Stanford is not currently accepting new patients for this trial. You may want to check clinicaltrials.gov to see if other locations are recruiting.
- biological : cetuximab
- drug : Cisplatin
- drug : Paclitaxel
- radiation : intensity-modulated radiation therapy (IMRT)
Phase: Phase 2
Ages Eligible For Study:
- Histologically or cytologically confirmed squamous cell carcinoma of the oropharynx as determined by Hematoxylin and eosin (H&E) staining - Newly diagnosed disease - Resectable disease OR disease that is expected to become resectable after study treatment - Stage III, IVA, or IVB disease as determined by imaging studies (computed tomography (CT) scan with IV contrast or magnetic resonance imaging (MRI) required) and a complete head and neck exam - Paraffin-embedded tumor specimen available for central confirmation of HPV-associated disease as determined by H&E staining and in-situ hybridization (ISH) for HPV-16 and immunohistochemistry (IHC) for p16 - HPV-associated disease is defined as p16 IHC-positive and/or HPV-16 ISH-positive - Non-HPV-associated disease is defined as p16 IHC-negative - NOTE: If there is limited tumor material, p16 IHC will be performed before HPV-16 ISH - Measurable disease of the primary tumor or nodes by clinical and radiographic methods, defined as a lesion that is ? 2 cm in at least one dimension by clinical exam AND by radiographic exam with CT scan or MRI (or a lesion that is ? 1 cm in at least one dimension if the radiographic exam utilizes spiral CT scan) - No primary tumor or nodal metastasis fixed to the carotid artery, skull base, or cervical spine - No evidence of distant metastases - Eastern Cooperative Oncology Group performance status 0-1 - Granulocytes ? 1,000/mm^3 - Platelet count ? 100,000/mm^3 - Total serum bilirubin ? 1.5 mg/dL - Creatinine clearance ? 60 mL/min - Negative pregnancy test - Fertile patients must use effective contraception - No history of another malignancy (except for carcinoma in situ of the cervix and/or nonmelanomatous skin cancer) unless it has been curatively treated and the patient has been disease-free for ? 2 years - Patients with any of the following within the past 6 months are eligible provided they have been evaluated by a cardiologist and/or neurologist before study entry: - New York Heart Association (NYHA) class III-IV congestive heart failure - Cerebrovascular accident or transient ischemic attack - Unstable angina - Myocardial infarction (with or without ST elevation)