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Prospective trial of synchronous bevacizumab, erlotinib, and concurrent chemoradiation in locally advanced head and neck cancer.

Publication ,  Journal Article
Yoo, DS; Kirkpatrick, JP; Craciunescu, O; Broadwater, G; Peterson, BL; Carroll, MD; Clough, R; MacFall, JR; Hoang, J; Scher, RL; Esclamado, RM ...
Published in: Clin Cancer Res
March 1, 2012

PURPOSE: We assessed the safety and efficacy of synchronous VEGF and epidermal growth factor receptor (EGFR) blockade with concurrent chemoradiation (CRT) in locally advanced head and neck cancer (HNC). EXPERIMENTAL DESIGN: Newly diagnosed patients with stage III/IV HNC received a 2-week lead-in of bevacizumab and/or erlotinib, followed by both agents with concurrent cisplatin and twice daily radiotherapy. Safety was assessed using Common Toxicity Criteria version 3.0. The primary efficacy endpoint was clinical complete response (CR) rate after CRT. RESULTS: Twenty-nine patients enrolled on study, with 27 completing therapy. Common grade III toxicities were mucositis (n = 14), dysphagia (n = 8), dehydration (n = 7), osteoradionecrosis (n = 3), and soft tissue necrosis (n = 2). Feeding tube placement was required in 79% but no patient remained dependent at 12-month posttreatment. Clinical CR after CRT was 96% [95% confidence interval (CI), 82%-100%]. Median follow-up was 46 months in survivors, with 3-year locoregional control and distant metastasis-free survival rates of 85% and 93%. Three-year estimated progression-free survival, disease-specific survival, and overall survival rates were 82%, 89%, and 86%, respectively. Dynamic contrast enhanced MRI (DCE-MRI) analysis showed that patients who had failed had lower baseline pretreatment median K(trans) values, with subsequent increases after lead-in therapy and 1 week of CRT. Patients who did not fail had higher median K(trans) values that decreased during therapy. CONCLUSIONS: Dual VEGF/EGFR inhibition can be integrated with CRT in locally advanced HNC, with efficacy that compares favorably with historical controls albeit with an increased risk of osteoradionecrosis. Pretreatment and early DCE-MRI may prospectively identify patients at high risk of failure.

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Published In

Clin Cancer Res

DOI

EISSN

1557-3265

Publication Date

March 1, 2012

Volume

18

Issue

5

Start / End Page

1404 / 1414

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Survival Analysis
  • Quinazolines
  • Oncology & Carcinogenesis
  • Neoplasm Staging
  • Middle Aged
  • Male
  • Magnetic Resonance Imaging
  • Humans
  • Head and Neck Neoplasms
 

Citation

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Yoo, D. S., Kirkpatrick, J. P., Craciunescu, O., Broadwater, G., Peterson, B. L., Carroll, M. D., … Brizel, D. M. (2012). Prospective trial of synchronous bevacizumab, erlotinib, and concurrent chemoradiation in locally advanced head and neck cancer. Clin Cancer Res, 18(5), 1404–1414. https://doi.org/10.1158/1078-0432.CCR-11-1982
Yoo, David S., John P. Kirkpatrick, Oana Craciunescu, Gloria Broadwater, Bercedis L. Peterson, Madeline D. Carroll, Robert Clough, et al. “Prospective trial of synchronous bevacizumab, erlotinib, and concurrent chemoradiation in locally advanced head and neck cancer.Clin Cancer Res 18, no. 5 (March 1, 2012): 1404–14. https://doi.org/10.1158/1078-0432.CCR-11-1982.
Yoo DS, Kirkpatrick JP, Craciunescu O, Broadwater G, Peterson BL, Carroll MD, et al. Prospective trial of synchronous bevacizumab, erlotinib, and concurrent chemoradiation in locally advanced head and neck cancer. Clin Cancer Res. 2012 Mar 1;18(5):1404–14.
Yoo, David S., et al. “Prospective trial of synchronous bevacizumab, erlotinib, and concurrent chemoradiation in locally advanced head and neck cancer.Clin Cancer Res, vol. 18, no. 5, Mar. 2012, pp. 1404–14. Pubmed, doi:10.1158/1078-0432.CCR-11-1982.
Yoo DS, Kirkpatrick JP, Craciunescu O, Broadwater G, Peterson BL, Carroll MD, Clough R, MacFall JR, Hoang J, Scher RL, Esclamado RM, Dunphy FR, Ready NE, Brizel DM. Prospective trial of synchronous bevacizumab, erlotinib, and concurrent chemoradiation in locally advanced head and neck cancer. Clin Cancer Res. 2012 Mar 1;18(5):1404–1414.

Published In

Clin Cancer Res

DOI

EISSN

1557-3265

Publication Date

March 1, 2012

Volume

18

Issue

5

Start / End Page

1404 / 1414

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Survival Analysis
  • Quinazolines
  • Oncology & Carcinogenesis
  • Neoplasm Staging
  • Middle Aged
  • Male
  • Magnetic Resonance Imaging
  • Humans
  • Head and Neck Neoplasms