A Study for Patients With Recurrent or Metastatic Squamous Cell Head and Neck Cancer

Phase 2 Study of Pemetrexed in Combination With Cisplatin and Cetuximab in Recurrent or Metastatic Squamous Cell Carcinoma of the Head and Neck

The purpose of this trial is to estimate progression free survival in patients with recurrent or metastatic head and neck cancer that have not received chemotherapy in this setting.

A 12 patient safety lead will evaluate side effects in patients receiving at least 2 cycles of the combination pemetrexed, cisplatin and cetuximab.

Inclusion Criteria:

• Histologically confirmed diagnosis of squamous cell carcinoma of head and neck (SCCHN)
• Recurrent or metastatic SCCHN, not amenable to local therapy
• At least 6 months since completion of systemic therapy (chemotherapy or biological anticancer therapy)
• No more than 1 prior systemic therapy, given as part of multimodal treatment for locally advanced disease;
• No prior systemic therapy for metastatic disease
• Radiation therapy must be completed at least 4 weeks before study enrollment.
• For palliative therapy, prior radiation therapy allowed to <25% of the bone marrow (Cristy and Eckerman 1987), and prior radiation to the whole pelvis is not allowed.
• Surgery (excluding prior diagnostic biopsy) must be completed at least 4 weeks before study enrollment.
• An estimated life expectancy of at least 12 weeks.
• Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1 (Oken et al. 1982).
• Biological tissue available for biomarker analysis on tumor tissue.
• Disease status may be measurable or nonmeasurable as defined by Response Evaluation Criteria in Solid Tumors
• Patient compliance and geographic proximity that allow for adequate follow-up.
• Adequate organ function
• Willingness to comply with Contraceptive Regimen
• For women: Must be surgically sterile, postmenopausal, or compliant with a medically approved contraceptive regimen [for example, intrauterine device (IUD), birth control pills, or barrier device] during and for 6 months after the treatment period; must have a negative serum or urine pregnancy test within 7 days before study enrollment, and must not be breast-feeding. For men: Must be surgically sterile or compliant with a contraceptive regimen during and for 6 months after the treatment period.

Exclusion Criteria:

• Nasopharyngeal, paranasal sinus, lip, or salivary gland cancer.
• Previously received treatment with monoclonal antibody therapy, or other signal transduction inhibitors of Epidermal Growth Factor Receptor therapy.
• Are receiving concurrent chronic systemic immune therapy, or chemotherapy for a disease other than cancer.
• Serious concomitant systemic disorder (for example, active infection) or psychiatric disorder that, in the opinion of the investigator, would compromise the patient's ability to complete the study.
• Have serious cardiac disease, such as symptomatic , unstable angina, or the history of myocardial infarction in the previous 12 months.
• Second primary malignancy that is clinically detectable at the time of consideration for study enrollment.
• Have had another primary malignancy other than Head and Neck cancer, unless that prior malignancy was treated at least 2 years previously with no evidence of recurrence. Exception: Patients with a history of in situ carcinoma of the cervix, nonmelanoma skin cancer, or low-grade (Gleason score less than or equal to 6) localized prostate cancer will be eligible even if diagnosed and treated less than 2 years previously.
• Presence of clinically significant (by physical exam) third-space fluid collections; for example, ascites or pleural effusions that cannot be controlled by drainage or other procedures prior to study entry.
• Have peripheral neuropathy
• Have central nervous system (CNS) metastases (unless the patient has completed successful local therapy for CNS metastases and has been off corticosteroids for at least 4 weeks before starting study therapy). Brain imaging is required in symptomatic patients to rule out brain metastases, but is not required in asymptomatic patients.
• Inability to interrupt aspirin or other nonsteroidal anti-inflammatory agents, other than an aspirin dose less than or equal to 1.3 grams per day, for a 5-day period (8-day period for long-acting agents, such as piroxicam).
• Unable or unwilling to take folic acid, vitamin B12, or prophylactic corticosteroids.
• Recent (within 30 days before enrollment) or concurrent yellow fever vaccination.
• Pregnant or breast-feeding