A Pilot Trial Targeting mTOR as a Novel Mechanism-Based Neoadjuvant Therapy for Head and Neck Cancer
18 Years
80 Years
Both
Mouth Neoplasms, Head and Neck Neoplasms, Tongue Neoplasms, Carcinoma, Squamous Cell
Trial Information
A Pilot Trial Targeting mTOR as a Novel Mechanism-Based Neoadjuvant Therapy for Head and Neck Cancer
BACKGROUND:
- The five-year survival rate for head and neck squamous cell carcinoma (HNSCC) has
remained at approximately 50% for more than three decades.
- In HNSCC, the AKT-mTOR-pS6 pathway is aberrantly activated and promotes tumorigenesis
and metastasis.
- Rapamycin is the most extensively studied mTOR inhibitor for which therapeutic daily
oral dose and schedule, pharmacologic levels in blood, and safety have been
established.
- Inhibition of mTOR by rapamycin causes the rapid apoptotic death of HNSCC tumor
xenografts and decreases the tumor burden and prolongs the survival of mice harboring
early and advanced oral and skin SCC lesions in a variety of experimental cancer
models.
- Preliminary evidence suggests that mTOR inhibitors cause tumor shrinkage and improved
tumor margins in HNSCC patients.
OBJECTIVES:
- The primary objectives are to evaluate the following for patients with HNSCC given
rapamycin as neoadjuvant treatment prior to surgery:
- Whether therapeutic activities of rapamycin lead to inhibition of mTOR complexes,
mTORC1 and mTORC2, as assessed by the change in levels of pS6 and pAkt473 measured
by immunohistochemistry (IHC) in tumor samples and by Western blotting in
peripheral blood mononuclear cells (PBMCs) and reduce tumor cell proliferation, as
judged by IHC for Ki-67 in tumor samples.
- Antitumor activity in terms of objective response.
- Secondary objectives include safety evaluation of rapamycin therapy, exploratory
studies of possible effects of rapamycin on tumor size, dynamic CT perfusion, and
FDG-PET; and evaluation of tumor proliferation, apoptosis, microvessel density, and
molecular changes associated with these effects. Survival status, recurrence of
disease, metastases, and adverse events/serious adverse events, including complications
of wound healing, which are related to rapamycin therapy will also be assessed for 360
days after surgery through medical record review.
ELIGIBILITY:
- Males and females age 18 years and older
- Previously untreated HNSCC of the oral cavity or oropharynx
- Clinical stage II, III, or IVA disease without distant metastasis
- Definitive therapy to include surgical resection for curative purposes
- Life expectancy greater than six months
STUDY DESIGN:
- Pilot, single arm, open-label, interventional neoadjuvant clinical trial.
- Twenty one evaluable subjects will take rapamycin (sirolimus) orally once per day for
21 days.
- Before and after dosing, the tumor will be photographed and biopsied, peripheral blood
mononuclear cells (PBMCs) will be collected, and computed tomography and positron
emission tomography scans will be performed.
- Surgical treatment, which is being provided outside of this protocol, will be conducted
after Day 28 and when rapamycin levels are less than or equal to 3 nanograms per
milliter.
- Subjects will be followed by medical record review for 360 days after surgery to assess
1) survival, 2) recurrence of disease, 3) metastases, and 4) adverse events/serious
adverse events that are related to rapamycin therapy, including complications of wound
healing and infections due to immune compromise.
- Levels of pS6 and pAkt473 in tumor tissue and PBMCs and Ki-67 in tumor tissue before
and after rapamycin therapy will be determined by immunohistochemistry and by Western
blotting. Computed tomography (CT) and positron emission tomography (PET) scans of the
head, neck, and chest region with and without contrast will be performed within 7 days
prior to the first rapamycin administration. One day after the last administration of
rapamycin the CT and PET scans (head and neck region only) with contrast will be
repeated.
- A single stage design will be used based on response defined as > 25% tumor shrinkage.
A Wilcoxon signed rank test will be used to compare levels of pS6, pAkt473, and Ki-67
before and after rapamycin therapy. As part of secondary analysis, the number of
subjects achieving a best response of complete response (CR), partial response (PR),
stable disease (SD), or progressive disease (PD) according to Response Evaluation
Criteria in Solid Tumors (RECIST) version 1.1 will also be summarized.
Inclusion Criteria
- ELIGIBILITY CRITERIA:
Males and females and members of any race or ethnic group who meet the eligibility
criteria may participate in this trial.
INCLUSION CRITERIA:
Participants must meet all of the following inclusion criteria:
1. Age 18 years and older
2. Histologically confirmed previously untreated squamous cell carcinoma o f the oral
cavity or oropharynx accessible for biopsy
3. Clinical stage II, III, or IVA disease without distant metastasis, as defined by the
American Joint Committee on Cancer Staging System, Seventh edition.
4. Definitive therapy to include surgical resection for curative purposes
5. Life expectancy o f greater than 6 months
6. Eastern Cooperative Oncology Group ( ECOG) performance status of 0 or 1
7. Willing and able to provide written informed consent
EXCLUSION CRITERIA:
Participants who meet any of the following criteria are not eligible for enrollment:
1. Surgical resection of the HNSCC is contraindicated
2. Prior head or neck squamous cell carcinoma, except for previously treated skin cancer
3. Received chemotherapy targeted monoclonal antibody therapy or investigational therapy
within 30 days prior to enrollment
4. Previous radiation therapy to the head or neck
5. No measurable tumor remaining after prior biopsy or negative margins from prior
biopsy
6. Inadequate hematologic, renal or liver function within l4 days prior to the first
rapamycin dosing visit, as defined by:
1. Absolute neutrophil count less than 1.5 times 10 (9)/L
2. CD4 count < 400 (to account for natural fluctuations in CD4 levels,
participants with at least one CD4 count >= 400 within 14 days prior to dosing
will not be excluded)
3. Platelet count less than 100 times 10(9)/L
4. Hemoglobin less than l0 g/dL (eligibility level for hemoglobin may be reached by
transfusion)
5. AST, ALT or bilirubin greater than 1.5 times the upper limit of local lab normal
values
6. Total cholesterol level greater than 350 mg/dL
7. Triglyceride level greater than 400 mg/dL
8. International Normalized Ratio (INR) greater than 1.5
9. Serum creatinine greater than 1.5mg/dL
7. Active hepatitis or HBV or HCV infection
8. Women who are pregnant or lactating (female of child-bearing age must be abstinent or
use a barrier type birth control method throughout the study)
9. Presence of any contraindications to rapamycin therapy, including HlV-protease
inhibitors and drugs or agents that are modulators of cytochrome P-450 3A4 (CYP3A4)
and p-glycoprotein(P-gp)
10. Hypersensitivity to rapamycin
11 .Has received live vaccine (such as influenza nasal vaccine measles mumps, rubella,
oral polio, B CG, yellow fever, varicella, or TY2la typhoid) in the past 30 days or has
plans to take a live vaccine in the next 3 months
12. Any cognitive impairment that limits the subject's or the subject's legally authorized
representative's ability to understand the protocol, provide informed consent or assent,
or to comply with the protocol procedures
13.Unable or unwilling to comply with the requirements of the protocol
Type of Study:
Interventional
Study Design:
Allocation: Non-Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment
Outcome Measure:
Evaluate the antitumoral activity of rapamycin in HNSCC patients in terms of objective responses; investigate underlying molecular changes to identify biomarkers for understanding, monitoring, and predicting a clinical response to rapamycin in H...
Principal Investigator
J. Silvio Gutkind, Ph.D.
Investigator Role:
Principal Investigator
Investigator Affiliation:
National Institute of Dental and Craniofacial Research (NIDCR)
Authority:
United States: Federal Government
Study ID:
100180
NCT ID:
NCT01195922
Start Date:
August 2010
Completion Date:
August 2013
Related Keywords:
- Mouth Neoplasms
- Head and Neck Neoplasms
- Tongue Neoplasms
- Carcinoma, Squamous Cell
- Head and Neck Squamous Cell Carcinoma
- Oral Cancer
- mTOR Inhibitors
- Targeted Therapies
- Signal Transduction Inhibitors
- Head and Neck Cancer
- Squamous Cell Carcinoma
- Tongue Cancer
- Neoplasms
- Carcinoma
- Carcinoma, Squamous Cell
- Head and Neck Neoplasms
- Mouth Neoplasms
- Tongue Neoplasms
Name | Location |
|---|---|
| National Institutes of Health Clinical Center, 9000 Rockville Pike | Bethesda, Maryland 20892 |
| Medical University of South Carolina | Charleston, South Carolina 29425-0721 |
