Cetuximab, Cisplatin, and Radiation Therapy in Treating Patients With Stage IB, Stage II, Stage III, or Stage IVA Cervical Cancer

Phase 1

Completed

• Conditions: Cervical Adenocarcinoma; Stage IB Cervical Cancer; Cervical Adenosquamous Carcinoma; Cervical Small Cell Carcinoma; Stage III Cervical Cancer; Stage IIA Cervical Cancer; Stage IIB Cervical Cancer; Cervical Squamous Cell Carcinoma; Stage IVA Cervical Cancer
• Interventions: Radiation: Internal Radiation Therapy; Radiation: 3-Dimensional Conformal Radiation Therapy; Biological: Cetuximab; Drug: Cisplatin

• Registration Number: NCT00104910
• Lead Sponsor: Gynecologic Oncology Group

Brief Summary

This phase I trial is studying the side effects and best dose of cetuximab when given together with cisplatin and radiation therapy in treating patients with stage IB, stage II, stage III, or stage IVA cervical cancer. 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. Drugs used in chemotherapy, such as cisplatin, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Radiation therapy uses high-energy x-rays and other types of radiation to kill tumor cells. Internal radiation therapy uses radioactive material placed directly into or near a tumor to kill tumor cells. Giving cetuximab together with cisplatin and radiation therapy may kill more tumor cells.

Detailed Description

PRIMARY OBJECTIVES:

I. Determine the maximum tolerated dose or safe biologically effective dose of cetuximab when administered in combination with cisplatin, external beam radiotherapy, and brachytherapy in patients with stage IB-IVA cervical cancer.

II. Determine the feasibility of this regimen, in terms of chronic and acute toxic effects, in these patients.

SECONDARY OBJECTIVES:

I. Determine the distribution of progression-free survival and overall survival of patients treated with this regimen at 1 year after study entry.

II. Determine the site of recurrence (locoregional vs distant) in patients treated with this regimen up to 1 year after study entry.

III. Correlate response or progression-free survival with epidermal growth factor receptor expression in tumor samples from patients treated with this regimen at 1 year after study entry.

IV. Correlate response or progression-free survival with grade of cetuximab-induced rash in patients treated with this regimen at 1 year after study entry.

OUTLINE: This is a multicenter, dose-escalation study of cetuximab. Patients are stratified according to nodal status (positive para-aortic and/or pelvic lymph nodes vs negative para-aortic and pelvic lymph nodes).

Patients receive cetuximab IV over 1-2 hours and cisplatin IV on days 1, 8, 15, 22, 29, and 36 (weeks 1-6). Patients also undergo external beam radiotherapy to the para-aortic and pelvic lymph nodes OR whole pelvis once daily on days 1-5, 8-12, 15-19, 22-26, and 29-33 (weeks 1-5). Patients then receive either 1 or 2 applications of low-dose rate brachytherapy in weeks 6-8 OR 5 applications of high-dose rate (HDR)\* brachytherapy once weekly in weeks 4-8. Treatment continues in the absence of disease progression or unacceptable toxicity.

NOTE: \*No external beam radiotherapy is administered on the day of HDR brachytherapy. If the majority of external beam radiotherapy has been administered, HDR brachytherapy may be administered in 2 applications per week (separated by at least 72 hours) in order to complete all treatment within 8 weeks.

Cohorts of 3-6 patients per stratum receive escalating doses of cetuximab until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity.

After completion of study treatment, patients are followed every 3 months for 1 year.

Study Timeline

• Study Start: 2005-01
• Study First Submitted: 2005-03-03
• Study First Submitted QC: 2005-03-03
• Study First Posted: 2005-03-04
• Primary Completion: 2013-01
• Status Verified: 2014-12
• Last Update Submitted: 2014-12-29
• Last Update Posted: 2014-12-31

Recruitment & Eligibility

• Status: COMPLETED
• Sex: Female
• Target Recruitment: 64

Inclusion Criteria

• Histologically confirmed cervical cancer

  • Clinical stage IB-IVA disease
  • Any cell type allowed

• Positive or negative pelvic and/or para-aortic lymph nodes by radiography

• Unstained sections from primary tumor available

• Performance status - GOG 0-1

• Absolute neutrophil count ≥ 1,500/mm^3

• Platelet count ≥ 100,000/mm^3

• Bilirubin ≤ 1.5 times upper limit of normal (ULN)

• SGOT ≤ 2.5 times ULN

• Alkaline phosphatase ≤ 2.5 times ULN

• Creatinine normal

• Creatinine clearance > 50 mL/min

• Patients with ureteral obstruction must undergo stent or nephrostomy tube placement prior to study entry

• No renal abnormality (e.g., pelvic kidney or horseshoe kidney) that would require modification of radiation fields

• No significant cardiac disease within the past 6 months, including any of the following:

  • Uncontrolled hypertension
  • Unstable angina
  • Congestive heart failure
  • Uncontrolled arrhythmia

• Not pregnant or nursing

• Negative pregnancy test

• Fertile patients must use effective contraception

• No sensory or motor neuropathy > grade 1

• No septicemia

• No severe infection

• No circumstance that would preclude study participation or follow-up

• No other invasive malignancy within the past 5 years except nonmelanoma skin cancer

• No uncontrolled seizure disorder

• No active neurologic disease

• No history of active collagen vascular disease

• No prior chimerized or murine monoclonal antibody therapy

• No prior cytotoxic chemotherapy for cervical cancer

• No prior pelvic or abdominal radiotherapy for cervical cancer

• No concurrent intensity modulated radiotherapy

• No prior renal transplantation

• More than 30 days since prior major surgery (excluding diagnostic biopsy)

• No other prior therapy for cervical cancer

• No prior cancer treatment that would preclude study therapy

• No other concurrent investigational agents

Exclusion Criteria

Not provided

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
Treatment (brachytherapy, radiation, cetuximab, cisplatin)	Internal Radiation Therapy	Patients receive cetuximab IV over 1-2 hours and cisplatin IV on days 1, 8, 15, 22, 29, and 36 (weeks 1-6). Patients also undergo external beam radiotherapy to the para-aortic and pelvic lymph nodes OR whole pelvis once daily on days 1-5, 8-12, 15-19, 22-26, and 29-33 (weeks 1-5). Patients then receive either 1 or 2 applications of low-dose rate brachytherapy in weeks 6-8 OR 5 applications of high-dose rate (HDR)\* brachytherapy once weekly in weeks 4-8. Treatment continues in the absence of disease progression or unacceptable toxicity.
Treatment (brachytherapy, radiation, cetuximab, cisplatin)	3-Dimensional Conformal Radiation Therapy	Patients receive cetuximab IV over 1-2 hours and cisplatin IV on days 1, 8, 15, 22, 29, and 36 (weeks 1-6). Patients also undergo external beam radiotherapy to the para-aortic and pelvic lymph nodes OR whole pelvis once daily on days 1-5, 8-12, 15-19, 22-26, and 29-33 (weeks 1-5). Patients then receive either 1 or 2 applications of low-dose rate brachytherapy in weeks 6-8 OR 5 applications of high-dose rate (HDR)\* brachytherapy once weekly in weeks 4-8. Treatment continues in the absence of disease progression or unacceptable toxicity.
Treatment (brachytherapy, radiation, cetuximab, cisplatin)	Cetuximab	Patients receive cetuximab IV over 1-2 hours and cisplatin IV on days 1, 8, 15, 22, 29, and 36 (weeks 1-6). Patients also undergo external beam radiotherapy to the para-aortic and pelvic lymph nodes OR whole pelvis once daily on days 1-5, 8-12, 15-19, 22-26, and 29-33 (weeks 1-5). Patients then receive either 1 or 2 applications of low-dose rate brachytherapy in weeks 6-8 OR 5 applications of high-dose rate (HDR)\* brachytherapy once weekly in weeks 4-8. Treatment continues in the absence of disease progression or unacceptable toxicity.
Treatment (brachytherapy, radiation, cetuximab, cisplatin)	Cisplatin	Patients receive cetuximab IV over 1-2 hours and cisplatin IV on days 1, 8, 15, 22, 29, and 36 (weeks 1-6). Patients also undergo external beam radiotherapy to the para-aortic and pelvic lymph nodes OR whole pelvis once daily on days 1-5, 8-12, 15-19, 22-26, and 29-33 (weeks 1-5). Patients then receive either 1 or 2 applications of low-dose rate brachytherapy in weeks 6-8 OR 5 applications of high-dose rate (HDR)\* brachytherapy once weekly in weeks 4-8. Treatment continues in the absence of disease progression or unacceptable toxicity.

Primary Outcome Measures

Name	Time	Method
Maximum tolerated dose (MTD) or biologically effective dose (BED) of Cetuximab in combination with cisplatin and extended field radiation or whole pelvis radiation, graded using Common Terminology Criteria for Adverse Events version 3.0 (CTCAE v3.0)	6 weeks	Evaluation of the regimens will be conducted separately by the type of radiation received (extended field radiation or whole pelvis radiation).
Incidence of toxicities at the MTD, assessed by CTCAE v3.0	Up to 1 year

Secondary Outcome Measures

Name	Time	Method
Progression-free survival	From study entry until disease progression, death or date of last contact, up to 1 year
Site of recurrence, loco-regional vs distant, assessed by clinical and radiological evaluation	From study entry until disease progression, death or date of last contact, up to 1 year
Frequency of chronic toxicities, assessed by CTCAE v3.0	From study entry until disease progression, death or date of last contact, up to 1 year

Trial Locations

Locations (15)

Cleveland Clinic Foundation; 🇺🇸 Cleveland, Ohio, United States

Georgia Regents University Medical Center; 🇺🇸 Augusta, Georgia, United States

University of Chicago Comprehensive Cancer Center; 🇺🇸 Chicago, Illinois, United States

Indiana University/Melvin and Bren Simon Cancer Center; 🇺🇸 Indianapolis, Indiana, United States

University of Iowa Hospitals and Clinics; 🇺🇸 Iowa City, Iowa, United States

Johns Hopkins University/Sidney Kimmel Comprehensive Cancer Center; 🇺🇸 Baltimore, Maryland, United States

Cooper Hospital University Medical Center; 🇺🇸 Camden, New Jersey, United States

MetroHealth Medical Center; 🇺🇸 Cleveland, Ohio, United States

Lake University Ireland Cancer Center; 🇺🇸 Mentor, Ohio, United States

Riverside Methodist Hospital; 🇺🇸 Columbus, Ohio, United States

University of Oklahoma Health Sciences Center; 🇺🇸 Oklahoma City, Oklahoma, United States

Women and Infants Hospital; 🇺🇸 Providence, Rhode Island, United States

Parkland Memorial Hospital; 🇺🇸 Dallas, Texas, United States

University of Texas Southwestern Medical Center; 🇺🇸 Dallas, Texas, United States

M D Anderson Cancer Center; 🇺🇸 Houston, Texas, United States