1. Phase 1 study of EGFR‐antisense DNA, cetuximab, and radiotherapy in head and neck cancer with preclinical correlatives
- Author
-
Bauman, Julie E, Duvvuri, Umamaheswar, Thomas, Sufi, Gooding, William E, Clump, David A, Karlovits, Brian, Wehbe, Ahmad, Miller, Frank R, Kim, Seungwon, Sen, Malabika, Heron, Dwight E, Grandis, Jennifer R, and Argiris, Athanassios
- Subjects
Biomedical and Clinical Sciences ,Clinical Sciences ,Oncology and Carcinogenesis ,Rare Diseases ,Cancer ,Radiation Oncology ,Clinical Trials and Supportive Activities ,Dental/Oral and Craniofacial Disease ,Orphan Drug ,Clinical Research ,6.1 Pharmaceuticals ,Aged ,Aged ,80 and over ,Animals ,Antineoplastic Combined Chemotherapy Protocols ,Cell Line ,Tumor ,Cell Survival ,Cetuximab ,Combined Modality Therapy ,DNA ,Antisense ,ErbB Receptors ,Female ,Genetic Therapy ,Head and Neck Neoplasms ,Humans ,Male ,Mice ,Mice ,Nude ,Middle Aged ,Molecular Targeted Therapy ,Protein Kinase Inhibitors ,Radiotherapy ,Adjuvant ,Squamous Cell Carcinoma of Head and Neck ,Xenograft Model Antitumor Assays ,antisense ,cetuximab ,epidermal growth factor receptor ,head and neck cancer ,oligonucleotide ,phase 2 ,Public Health and Health Services ,Oncology & Carcinogenesis ,Oncology and carcinogenesis ,Public health - Abstract
BackgroundCetuximab combined with radiation therapy (RT) is an evidence-based treatment for locally advanced head and neck squamous cell carcinoma (HNSCC); however, locoregional failure remains the primary cause of cancer-related death in this disease. Intratumoral injection of epidermal growth factor receptor (EGFR)-antisense plasmid DNA (EGFR-AS) is safe and has been associated with promising lesional responses in patients who have recurrent/metastatic HNSCC. For the current study, the authors investigated the antitumor effects of cetuximab and EGFR-AS in preclinical HNSCC models and reported their phase 1 experience adding intratumoral EGFR-AS to cetuximab RT.MethodsAntitumor mechanisms were investigated in cell line and xenograft models. Phase 1 trial eligibility required stage IVA through IVC HNSCC and a measurable lesion accessible for repeat injections. Patients received standard cetuximab was for 9 weeks. EGFR-AS was injected weekly until they achieved a lesional complete response. RT was delivered by conventional fractionation for 7 weeks, starting at week 3. Research biopsies were obtained at baseline and week 2.ResultsWhen added to cetuximab, EGFR-AS decreased cell viability and xenograft growth compared with EGFR-sense control, partially mediated by reduced EGFR expression. Six patients were enrolled in the phase 1 cohort. No grade 2 or greater EGFR-AS-related adverse events occurred. The best lesional response was a complete response (4 patients), and 1 patient each had a partial response and disease progression. EGFR expression decreased in 4 patients who had available paired specimens.ConclusionsIn preclinical models, dual EGFR inhibition with cetuximab and EGFR-AS enhanced antitumor effects. In a phase 1 cohort, intratumoral EGFR-AS injections, cetuximab, and RT were well tolerated. A phase 2 trial is needed to conduct an extended evaluation of safety and to establish efficacy.
- Published
- 2018