Open AccessApproval Summary: Cetuximab in Combination With Cisplatin or Carboplatin and 5‐Fluorouracil for the First‐Line Treatment of Patients With Recurrent Locoregional or Metastatic Squamous Cell Head and Neck Cancer
Author(s) -
Cohen Martin H.,
Chen Huanyu,
Shord Stacy,
Fuchs Chana,
He Kun,
Zhao Hong,
Sickafuse Sharon,
Keegan Patricia,
Pazdur Richard
Publication year - 2013
Publication title -
the oncologist
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.176
H-Index - 164
eISSN - 1549-490X
pISSN - 1083-7159
DOI - 10.1634/theoncologist.2012-0458
Subject(s) - cetuximab , medicine , carboplatin , regimen , oncology , head and neck cancer , fluorouracil , clinical endpoint , cisplatin , hazard ratio , colorectal cancer , cancer , chemotherapy , randomized controlled trial , confidence interval
Learning ObjectivesCompare survival outcomes among patients with SCCHN treated with a platinum/5 ‐FU regimen with and without cetuximab. Compare adverse event profiles among patients with SCCHN treated with a platinum/5 ‐FU regimen with and without cetuximab. Describe potential risk‐benefit issues identified in the EU and US studies.On November 7, 2011, the U.S. Food and Drug Administration approved cetuximab in combination with cisplatin or carboplatin and 5‐fluorouracil for the first‐line treatment of patients with recurrent locoregional or metastatic squamous cell head and neck cancer. Approval was based on a randomized study of 442 patients conducted outside the U.S. Cisplatin (100 mg/m 2 intravenously) or carboplatin (area under the curve 5 intravenously) on day 1 with 5‐fluorouracil (1,000 mg/m 2 /day continuous intravenous infusion days 1–4) were administered every 3 weeks. Cetuximab, 400 mg/m 2 intravenously, was administered initially followed by cetuximab, 250 mg/m 2 intravenously weekly. After completion of six planned treatment courses, cetuximab patients without progression continued cetuximab 250 mg/m 2 weekly. The study used European Union (EU)‐approved cetuximab rather than U.S.‐approved cetuximab. U.S.‐approved cetuximab provides approximately 28% higher exposure relative to EU‐approved cetuximab in a pharmacokinetic comparability study in monkeys. Overall survival, the primary efficacy endpoint, was significantly improved in cetuximab‐treated patients (hazard ratio [HR]: 0.80; 95% confidence interval [CI]: 0.64–0.98; p = .034, stratified log‐rank test). Median survival times were 10.1 and 7.4 months, respectively. Progression‐free survival (PFS) was also significantly improved in patients receiving cetuximab (HR: 0.57; 95% CI: 0.46–0.72; p < .0001). Median PFS times were 5.5 and 3.3 months, respectively. Response rates were 35.6% and 19.5% (odds ratio: 2.33; 95% CI: 1.50–3.60; p = .0001). Adverse reactions (≥25%) from cetuximab plus chemotherapy treatment included nausea, anemia, vomiting, neutropenia, rash, asthenia, diarrhea, and anorexia. Conjunctivitis occurred in 10% of cetuximab patients. Other adverse reactions, sometimes severe, included infusion reactions, hypomagnesemia, hypocalcemia, and hypokalemia.