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Report for Clinical Trial NCT01816984

Developed by Shray Alag, 2020.
SNP Clinical Trial Gene

A Biomarker Driven Pilot Study of the Pan-class I PI3K Inhibitor NVP-BKM120 in Combination With Cetuximab in Patients With Recurrent/Metastatic Head and Neck Cancer

This pilot randomized phase I/II trial studies the side effects and best dose of PI3K inhibitor BKM120 when given together with cetuximab and to see how well it works in treating patients with recurrent or metastatic head and neck cancer. PI3K inhibitor BKM120 may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Monoclonal antibodies, such as cetuximab, can block tumor growth in different ways. Some block the ability of tumors to grow and spread. Others find tumor cells and help kill them or carry tumor-killing substances to them. Giving PI3K inhibitor BKM120 together with cetuximab may kill more tumor cells

NCT01816984 Metastatic Squamous Neck Cancer With Occult Primary Squamous Cell Carcinoma Recurrent Metastatic Squamous Neck Cancer With Occult Primary Recurrent Salivary Gland Cancer Recurrent Squamous Cell Carcinoma of the Hypopharynx Recurrent Squamous Cell Carcinoma of the Larynx Recurrent Squamous Cell Carcinoma of the Lip and Oral Cavity Recurrent Squamous Cell Carcinoma of the Nasopharynx Recurrent Squamous Cell Carcinoma of the Oropharynx Recurrent Squamous Cell Carcinoma of the Paranasal Sinus and Nasal Cavity Recurrent Verrucous Carcinoma of the Larynx Recurrent Verrucous Carcinoma of the Oral Cavity Salivary Gland Squamous Cell Carcinoma Stage IV Squamous Cell Carcinoma of the Hypopharynx Stage IV Squamous Cell Carcinoma of the Nasopharynx Stage IVA Salivary Gland Cancer Stage IVA Squamous Cell Carcinoma of the Larynx Stage IVA Squamous Cell Carcinoma of the Lip and Oral Cavity Stage IVA Squamous Cell Carcinoma of the Oropharynx Stage IVA Squamous Cell Carcinoma of the Paranasal Sinus and Nasal Cavity Stage IVA Verrucous Stage IVA Verrucous Carcinoma of the Larynx Stage IVA Verrucous Carcinoma of the Oral Cavity Stage IVB Salivary Gland Cancer Stage IVB Squamous Cell Carcinoma of the Larynx Stage IVB Squamous Cell Carcinoma of the Lip and Oral Cavity Stage IVB Squamous Cell Carcinoma of the Oropharynx Stage IVB Squamous Cell Carcinoma of the Paranasal Sinus and Nasal Cavity Stage IVB Verrucous Carcinoma of the Larynx Stage IVB Verrucous Carcinoma of the Oral Cavity Stage IVC Salivary Gland Cancer Stage IVC Squamous Cell Carcinoma of the Larynx Stage IVC Squamous Cell Carcinoma of the Lip and Oral Cavity Stage IVC Squamous Cell Carcinoma of the Oropharynx Stage IVC Squamous Cell Carcinoma of the Paranasal Sinus and Nasal Cavity Stage IVC Verrucous Carcinoma of the Larynx Stage IVC Verrucous Carcinoma of the Oral Cavity Tongue Cancer
MeSH:Carcinoma Carcinoma, Squa Carcinoma, Squamous Cell Head and Neck Neoplasms Laryngeal Neoplasms Oropharyngeal Neoplasms Carcinoma, Verrucous Salivary Gland Neoplasms Nasopharyngeal Carcinoma Paranasal Sinus Neoplasms Neoplasms, Unknown Primary Tongue Neoplasms Laryngeal Diseases
HPO:Carcinoma Neoplasm of head and neck Neoplasm of the larynx Neoplasm of the tongue Paranasal sinus neoplasm Salivary gland neoplasm Squamous cell carcinoma

4 Interventions

Name: PI3K inhibitor BKM120

Description: Given PO
Type: Drug
Group Labels: 1

Arm I (one-week run-in period)

Name: cetuximab

Description: Given IV
Type: Biological
Group Labels: 2

Arm I (one-week run-in period) Arm II (no one-week run-in period)

Name: laboratory biomarker analysis

Description: Correlative studies
Type: Other
Group Labels: 2

Arm I (one-week run-in period) Arm II (no one-week run-in period)

Name: questionnaire administration

Description: Ancillary studies
Type: Other
Group Labels: 2

Arm I (one-week run-in period) Arm II (no one-week run-in period)


Primary Outcomes

Description: Performed using snap frozen tissue samples using the well-established PamGene Kinase array platform available in the Salgia/Seiwert laboratories.

Measure: Compensatory signaling/feedback loop signaling evaluated by measurement of phosphorylated (p)-EGFR

Time: 1 week

Measure: Maximum tolerated dose (MTD) defined as the dose level preceding the dose in which greater than or equal to 2 out of 3-6 patients experience a dose limiting toxicity (DLT) assessed using CTCAE v4

Time: 28 days

Secondary Outcomes

Description: Measured by Terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay on Formalin-Fixed, Paraffin-Embedded (FFPE) sections in a descriptive manner.

Measure: Apoptosis induction

Time: Up to 28 days

Measure: Response rate assessed using RECIST

Time: Up to 28 days

Measure: Response rate in patients with prior EGFR failure assessed using RECIST

Time: Up to 28 days

Description: Tumor shrinkage will be visualized as a waterfall plot for graphical (qualitative) comparison.

Measure: Tumor shrinkage

Time: Up to 28 days

Description: Kaplan-Meier curves will be generated. Logistic and Cox proportional hazards regression models will also be used.

Measure: Overall survival

Time: Up to 28 days

Description: Kaplan-Meier curves will be generated. Logistic and Cox proportional hazards regression models will also be used.

Measure: Progression free survival

Time: Up to 28 days

Purpose: Treatment

Allocation: Randomized

Parallel Assignment


There is one SNP

SNPs


1 P13K

cisplatin or carboplatin) in a prior line of therapy, or documented intolerance to such an agent - Eastern Cooperative Oncology Group (ECOG) performance status =< 2 - No more than two lines of prior cytotoxic chemotherapy in the recurrent/metastatic (palliative intent) treatment setting - Prior use of cetuximab or another epidermal growth factor receptor (EGFR) inhibitor is allowable and if used as a single agent should not be considered as a cytotoxic chemotherapy - Patients must have at least one site of measurable disease (if applicable) (per RECIST for solid tumors or the appropriate disease classification/criteria for the target population) - Absolute neutrophil count (ANC) >= 1.5 x 10^9/L - Platelets >= 100 x 10^9/L - Hemoglobin (Hb) > 9 g/dL - Total calcium (corrected for serum albumin) within normal limits - Magnesium >= the lower limit of normal for the institution - Potassium within normal limits for the institution - Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) within 1.5 x normal range (or =< 3.0 x upper limit of normal [ULN] if liver metastases are present) - Serum bilirubin within normal range (or =< 1.5 x ULN if liver metastases are present; or total bilirubin =< 3.0 x ULN with direct bilirubin within normal range in patients with well documented Gilbert syndrome) - Serum creatinine =< 1.5 x ULN or 24-hour clearance >= 50 mL/min - Serum amylase =< ULN - Serum lipase =< ULN - Fasting plasma glucose =< 120 mg/dL (6.7 mmol/L) - Negative serum pregnancy test within 72 hours before starting study treatment in women with childbearing potential - Signed informed consent - International normalized ratio (INR) =< 2.5 Exclusion Criteria: - Patients who have received prior treatment with a P13K inhibitor - No available tumor material for correlative studies - Patients with a known hypersensitivity to BKM120 or to its excipients, or hypersensitivity to cetuximab - More than two prior lines of cytotoxic chemotherapy in the recurrent/metastatic disease setting (palliative treatment intent)(excluding single agent use of an EGFR inhibitor) - Patients with untreated brain metastases are excluded; however, patients with treated brain metastases are eligible if they are > 4 weeks from therapy completion (including radiation and/or surgery), are clinically stable at the time of study entry and are not receiving corticosteroid therapy at the time of study entry - Patients with acute or chronic liver, renal disease or pancreatitis - Patients with the following mood disorders as judged by the Investigator or a psychiatrist, or as a result of patient's mood assessment questionnaire (treating physician to decide on whether to administer questionnaire): - Medically documented history of or active major depressive episode, bipolar disorder (I or II), obsessive-compulsive disorder, schizophrenia, a history of suicidal attempt or ideation, or homicidal ideation (immediate risk of doing harm to others) - >= Common Terminology Criteria for Adverse Events (CTCAE) version 4 (v4) grade 3 anxiety - Meets the cut-off score of >= 10 in the Patient Health Questionnaire 9 (PHQ-9) or a cut-off of >= 15 in the Generalized Anxiety Disorder 7 (GAD-7) mood scale, respectively, or selects a positive response of "1, 2, or 3" to question number 9 regarding potential for suicidal thoughts in the PHQ-9 (independent of the total score of the PHQ-9) - Patients with diarrhea >= CTCAE v4 grade 2 - Patient has active cardiac disease including any of the following: - History of clinically significant heart failure (previously assessed) with a left ventricular ejection fraction (LVEF) of < 50% as determined by multiple grated acquisition (MUGA) scan or echocardiogram (ECHO) - Corrected QT (QTc) > 480 msec on screening electrocardiogram (ECG) (using the Fridericia QT correction [QTcF] formula) - Angina pectoris that requires the use of anti-anginal medication - Ventricular arrhythmias except for benign premature ventricular contractions - Supraventricular and nodal arrhythmias requiring a pacemaker or not controlled with medication - Conduction abnormality requiring a pacemaker - Valvular disease with document compromise in cardiac function - Symptomatic pericarditis - Patient has a history of cardiac dysfunction including any of the following: - Myocardial infraction within the last 6 months, documented by persistent elevated cardiac enzymes or persistent regional wall abnormalities on assessment of LVEF function - History of documented congestive heart failure (New York Heart Association functional classification III-IV) - Documented cardiomyopathy - Patient has poorly controlled diabetes mellitus or steroid-induced diabetes mellitus (hemoglobin A1C [HbA1C] > 7.5%) - Patients with any history of hyperglycemia (elevated blood glucose level on blood chemistries) should be considered for initiation of Metformin treatment (500mg, PO, twice daily) prior to starting BKM120 - Other concurrent severe and/or uncontrolled concomitant medical conditions (e.g., active or uncontrolled infection) that could cause unacceptable safety risks or compromise compliance with the protocol - Significant symptomatic deterioration of lung function; if clinically indicated, pulmonary function tests including measures of predicted lung volumes, diffusing capacity of the lung for carbon monoxide (DLCO), oxygen (O2) saturation at rest on room air should be considered to exclude pneumonitis or pulmonary infiltrates - Impairment of gastrointestinal (GI) function or GI disease that may significantly alter the absorption of BKM120 (e.g., ulcerative diseases, uncontrolled nausea, vomiting, diarrhea, malabsorption syndrome, or small bowel resection); patients with unresolved diarrhea will be excluded as previously indicated - Patients who have been treated with any hematopoietic colony-stimulating growth factors (e.g., filgrastim [G-CSF], sargramostim [GM-CSF]) =< 2 weeks prior to starting study drug; erythropoietin or darbepoetin therapy, if initiated at least 2 weeks prior to enrollment, may be continued - Patients who are currently receiving treatment with medication with a known risk to prolong the QT interval or inducing Torsades de Pointes and the treatment cannot either be discontinued or switched to a different medication prior to starting study drug - Patients receiving chronic treatment with steroids or another immunosuppressive agent other than specified in exclusion criterion #4 - Note: Topical applications (e.g. --- P13K ---



HPO Nodes


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