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Randomised Phase II study of oral lapatinib combined with chemoradiotherapy in patients with advanced squamous cell carcinoma of the head and neck: Rationale for future randomised trials in human papilloma virus-negative disease

Authors
Journal
European Journal of Cancer
0959-8049
Publisher
Elsevier
Volume
49
Issue
7
Identifiers
DOI: 10.1016/j.ejca.2012.11.023
Keywords
  • Head And Neck Cancer
  • Chemotherapy
  • Radiotherapy
  • Chemoradiotherapy
  • Epidermal Growth Factor Receptor
  • Human Papilloma Virus
Disciplines
  • Medicine

Abstract

Abstract Background This randomised Phase II study assessed the activity and safety of concurrent chemoradiotherapy (CRT) and lapatinib followed by maintenance treatment in locally advanced, unresected stage III/IVA/IVB head and neck cancer. Patients and methods Patients were randomised 1:1 to concurrent CRT and placebo followed by placebo or concurrent CRT and lapatinib followed by lapatinib. Treatment continued until disease progression or study withdrawal. Primary end-point was complete response rate (CRR) by independent review 6 months post-CRT. Results Sixty-seven patients (median age 56 years; 97% Eastern Cooperative Oncology Group performance status ⩽1; 82% stage IV) were recruited. CRT dose intensities were unaffected by lapatinib: median radiation dose 70Gy (lapatinib, placebo), duration 49 (lapatinib) and 50 days (placebo); median cisplatin dose 260mg/m2 (lapatinib) and 280mg/m2 (placebo). Lapatinib combined with CRT was well-tolerated. Grade 3/4 toxicities during CRT were balanced between arms, with the exception of an excess of grade 3 diarrhoea (6% versus 0%) and rash (9% versus 3%) and two grade 4 cardiac events in the lapatinib arm. CRR at 6 months post-CRT was 53% with lapatinib versus 36% with placebo in the intent-to-treat population. The progression-free survival (PFS) and overall survival rates at 18 months were 55% versus 41% and 68% versus 57% for the lapatinib and placebo arms, respectively. The difference between study arms was greatest in p16-negative disease (median PFS >20.4 months [lapatinib] versus 10.9 [placebo]). Conclusion Lapatinib combined with CRT is well-tolerated with numeric increases in CRR at 6 months post-CRT and median PFS in p16-negative disease.

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