AFATINIB FOR HEAD-NECK CANCER

Ann Oncol. 2014 Jun 13. pii: mdu216. [Epub ahead of print]

A randomized, phase 2 study of afatinib versus cetuximab in metastatic or recurrent squamous cell carcinoma of the head and neck.

Seiwert TY1, Fayette J2, Cupissol D3, Del Campo JM4, Clement PM5, Hitt R6, Degardin M7, Zhang W8, Blackman A9, Ehrnrooth E10, Cohen EE11.

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Abstract

BACKGROUND:

Afatinib is an oral, irreversible ErbB family blocker that has shown activity in epidermal growth factor receptor (EGFR)-mutated lung cancer. We hypothesized that the agent would have greater anti-tumor activity compared to cetuximab in recurrent/metastatic (R/M) head and neck squamous cell carcinoma (HNSCC) patients, whose disease has progressed after platinum-containing therapy.

PATIENTS AND METHODS:

An open-label, randomized, phase 2 trial was conducted in 43 centers; 124 patients were randomized (1:1) to either afatinib (50 mg/day) or cetuximab (250 mg/m2/week) until disease progression or intolerable adverse events (AEs) (Stage I), with optional crossover (Stage II). The primary endpoint was tumor shrinkage before crossover assessed by investigator (IR) and independent central review (ICR).

RESULTS:

A total of 121 patients were treated (61 afatinib, 60 cetuximab) and 68 crossed over to Stage II (32 and 36 respectively). In Stage I, mean tumor shrinkage by IR/ICR was 10.4%/16.6% with afatinib and 5.4%/10.1% with cetuximab (P=0.46/0.30). Objective response rate was 16.1%/8.1% with afatinib and 6.5%/9.7% with cetuximab (IR/ICR). Comparable disease control rates were observed with afatinib (50%) and cetuximab (56.5%) by IR; similar results were seen by ICR. Most common grade ≥3 drug-related AEs (DRAEs) were rash/acne (18% versus 8.3%), diarrhea (14.8% versus 0%), and stomatitis/mucositis (11.5% versus 0%) with afatinib and cetuximab, respectively. Patients with DRAEs leading to treatment discontinuation were 23% with afatinib and 5% with cetuximab. In Stage II, disease control rate (IR/ICR) was 38.9%/33.3% with afatinib and 18.8%/18.8% with cetuximab.

CONCLUSION:

Afatinib showed anti-tumor activity comparable to cetuximab in R/M HNSCC in this exploratory phase 2 trial, although more patients on afatinib discontinued treatment due to AEs. Sequential EGFR/ErbB treatment with afatinib and cetuximab provided sustained clinical benefit in patients after crossover suggesting a lack of cross-resistance.