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Journal of Clinical Oncology, Vol 22, No 1 (January 1), 2004: pp. 77-85
© 2004 American Society of Clinical Oncology.
DOI: 10.1200/JCO.2004.06.075

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Multicenter Phase II Study of Erlotinib, an Oral Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitor, in Patients With Recurrent or Metastatic Squamous Cell Cancer of the Head and Neck

Denis Soulieres, Neil N. Senzer, Everett E. Vokes, Manuel Hidalgo, Sanjiv S. Agarwala, Lillian L. Siu

From the CHUM, Hospital Notre Dame, Montreal, Quebec; Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada; US Oncology, Dallas; Cancer Therapy and Research Center, San Antonio, TX; the University of Chicago, Chicago, IL; and the Pittsburgh Clinical Research Network, Pittsburgh, PA.

Address reprint requests to Lillian L. Siu, MD, FRCPC, Princess Margaret Hospital, University Health Network, 610 University Ave, Suite 5-210, Toronto, Ontario, M5G 2M9 Canada; e-mail: lillian.siu{at}uhn.on.ca

PURPOSE: To determine the efficacy and safety profiles of erlotinib in patients with advanced recurrent and/or metastatic squamous cell cancer of the head and neck (HNSCC).

PATIENTS AND METHODS: Patients with locally recurrent and/or metastatic HNSCC, regardless of their HER1/EGFR status, were treated with erlotinib at an initial dose of 150 mg daily. Dose reductions or escalations were allowed based on tolerability of erlotinib.

RESULTS: One-hundred fifteen patients were enrolled onto this study. Forty-seven percent of patients received erlotinib at 150 mg daily throughout the entire study, 6% had dose escalations, and 46% required dose reductions and/or interruptions. Five patients achieved partial responses on study, for an overall objective response rate of 4.3% (95% CI, 1.4% to 9.9%). Disease stabilization was maintained in 44 patients (38.3%) for a median duration of 16.1 weeks. The median progression-free survival was 9.6 weeks (95% CI, 8.1 to 12.1 weeks), and the median overall survival was 6.0 months (95% CI, 4.8 to 7.0 months). Subgroup analyses revealed a significant difference in overall survival favoring patients who developed at least grade 2 skin rashes versus those who did not (P = .045), whereas no difference was detected based on HER1/EGFR expression. Rash and diarrhea were the most common drug-related toxicities, encountered in 79% and 37% of patients, respectively, though the severity was mild to moderate in most cases.

CONCLUSION: Erlotinib was well tolerated in this heavily pretreated HNSCC population and produced prolonged disease stabilization; hence, further evaluation of its role in this tumor type is warranted.

Supported by OSI Pharmaceuticals Inc; Hoffman-La Roche Inc; and Genentech Inc.

Presented in part at the 37th Annual Meeting of the American Society of Clinical Oncology, San Francisco, CA, May 12-15, 2001.

Authors' disclosures of potential conflicts of interest are found at the end of this article.


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Phase II Multicenter Study of the Antiepidermal Growth Factor Receptor Monoclonal Antibody Cetuximab in Combination With Platinum-Based Chemotherapy in Patients With Platinum-Refractory Metastatic and/or Recurrent Squamous Cell Carcinoma of the Head and Neck
J. Clin. Oncol., August 20, 2005; 23(24): 5568 - 5577.
[Abstract] [Full Text] [PDF]


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JCOHome page
R. Perez-Soler and L. Saltz
Cutaneous Adverse Effects With HER1/EGFR-Targeted Agents: Is There a Silver Lining?
J. Clin. Oncol., August 1, 2005; 23(22): 5235 - 5246.
[Abstract] [Full Text] [PDF]


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Clin. Cancer Res.Home page
T. Friess, W. Scheuer, and M. Hasmann
Combination Treatment with Erlotinib and Pertuzumab against Human Tumor Xenografts Is Superior to Monotherapy
Clin. Cancer Res., July 15, 2005; 11(14): 5300 - 5309.
[Abstract] [Full Text] [PDF]


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Ann OncolHome page
M.-C. Etienne-Grimaldi, S. Pereira, N. Magne, J.-L. Formento, M. Francoual, X. Fontana, F. Demard, O. Dassonville, G. Poissonnet, J. Santini, et al.
Analysis of the dinucleotide repeat polymorphism in the epidermal growth factor receptor (EGFR) gene in head and neck cancer patients
Ann. Onc., June 1, 2005; 16(6): 934 - 941.
[Abstract] [Full Text] [PDF]


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JCOHome page
M. K. Gibson, Y. Li, B. Murphy, M. H.A. Hussain, R. C. DeConti, J. Ensley, and A. A. Forastiere
Randomized Phase III Evaluation of Cisplatin Plus Fluorouracil Versus Cisplatin Plus Paclitaxel in Advanced Head and Neck Cancer (E1395): An Intergroup Trial of the Eastern Cooperative Oncology Group
J. Clin. Oncol., May 20, 2005; 23(15): 3562 - 3567.
[Abstract] [Full Text] [PDF]


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The OncologistHome page
R. Perez-Soler, J. P. Delord, A. Halpern, K. Kelly, J. Krueger, B. M. Sureda, J. von Pawel, J. Temel, S. Siena, D. Soulieres, et al.
HER1/EGFR Inhibitor-Associated Rash: Future Directions for Management and Investigation Outcomes from the HER1/EGFR Inhibitor Rash Management Forum
Oncologist, May 1, 2005; 10(5): 345 - 356.
[Abstract] [Full Text] [PDF]


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Cancer Res.Home page
P. Chinnaiyan, S. Huang, G. Vallabhaneni, E. Armstrong, S. Varambally, S. A. Tomlins, A. M. Chinnaiyan, and P. M. Harari
Mechanisms of Enhanced Radiation Response following Epidermal Growth Factor Receptor Signaling Inhibition by Erlotinib (Tarceva)
Cancer Res., April 15, 2005; 65(8): 3328 - 3335.
[Abstract] [Full Text] [PDF]


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JCOHome page
R. S. Herbst, D. H. Johnson, E. Mininberg, D. P. Carbone, T. Henderson, E. S. Kim, G. Blumenschein Jr, J. J. Lee, D. D. Liu, M. T. Truong, et al.
Phase I/II Trial Evaluating the Anti-Vascular Endothelial Growth Factor Monoclonal Antibody Bevacizumab in Combination With the HER-1/Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitor Erlotinib for Patients With Recurrent Non-Small-Cell Lung Cancer
J. Clin. Oncol., April 10, 2005; 23(11): 2544 - 2555.
[Abstract] [Full Text] [PDF]


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JCOHome page
W. Pao and V. A. Miller
Epidermal Growth Factor Receptor Mutations, Small-Molecule Kinase Inhibitors, and Non-Small-Cell Lung Cancer: Current Knowledge and Future Directions
J. Clin. Oncol., April 10, 2005; 23(11): 2556 - 2568.
[Abstract] [Full Text] [PDF]


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Ann OncolHome page
G. Giaccone
HER1/EGFR-targeted agents: predicting the future for patients with unpredictable outcomes to therapy
Ann. Onc., April 1, 2005; 16(4): 538 - 548.
[Abstract] [Full Text] [PDF]


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Cold Spring Harb Symp Quant BiolHome page
R.K. THOMAS, H. GREULICH, Y. YUZA, J.C. LEE, T. TENGS, W. FENG, T.-H. CHEN, E. NICKERSON, J. SIMONS, M. EGHOLM, et al.
Detection of Oncogenic Mutations in the EGFR Gene in Lung Adenocarcinoma with Differential Sensitivity to EGFR Tyrosine Kinase Inhibitors
Cold Spring Harb Symp Quant Biol, January 1, 2005; 70(0): 73 - 81.
[Abstract] [PDF]


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Ann OncolHome page
P. M. Harari
Promising new advances in head and neck radiotherapy
Ann. Onc., January 1, 2005; 16(suppl_6): vi13 - vi19.
[Abstract] [Full Text] [PDF]


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Ann OncolHome page
J. Bourhis
New approaches to enhance chemotherapy in SCCHN
Ann. Onc., January 1, 2005; 16(suppl_6): vi20 - vi24.
[Abstract] [Full Text] [PDF]


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Ann OncolHome page
E. Vokes
Current treatments and promising investigations in a multidisciplinary setting
Ann. Onc., January 1, 2005; 16(suppl_6): vi25 - vi30.
[Abstract] [Full Text] [PDF]


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Cancer Res.Home page
M. L. Amador, D. Oppenheimer, S. Perea, A. Maitra, G. Cusati, C. Iacobuzio-Donahue, S. D. Baker, R. Ashfaq, C. Takimoto, A. Forastiere, et al.
An Epidermal Growth Factor Receptor Intron 1 Polymorphism Mediates Response to Epidermal Growth Factor Receptor Inhibitors
Cancer Res., December 15, 2004; 64(24): 9139 - 9143.
[Abstract] [Full Text] [PDF]


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Endocr Relat CancerHome page
P M Harari
Epidermal growth factor receptor inhibition strategies in oncology
Endocr. Relat. Cancer, December 1, 2004; 11(4): 689 - 708.
[Abstract] [Full Text] [PDF]


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Clin. Cancer Res.Home page
W. J. Petty, K. H. Dragnev, V. A. Memoli, Y. Ma, N. B. Desai, A. Biddle, T. H. Davis, W. C. Nugent, N. Memoli, M. Hamilton, et al.
Epidermal Growth Factor Receptor Tyrosine Kinase Inhibition Represses Cyclin D1 in Aerodigestive Tract Cancers
Clin. Cancer Res., November 15, 2004; 10(22): 7547 - 7554.
[Abstract] [Full Text] [PDF]


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Cancer Res.Home page
O. G. Yigitbasi, M. N. Younes, D. Doan, S. A. Jasser, B. A. Schiff, C. D. Bucana, B. N. Bekele, I. J. Fidler, and J. N. Myers
Tumor Cell and Endothelial Cell Therapy of Oral Cancer by Dual Tyrosine Kinase Receptor Blockade
Cancer Res., November 1, 2004; 64(21): 7977 - 7984.
[Abstract] [Full Text] [PDF]


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Clin. Cancer Res.Home page
V. Gregorc, G. L. Ceresoli, I. Floriani, A. Spreafico, K. B. Bencardino, V. Ludovini, L. Pistola, Z. Mihaylova, F. R. Tofanetti, M. Ferraldeschi, et al.
Effects of Gefitinib on Serum Epidermal Growth Factor Receptor and HER2 in Patients with Advanced Non-Small Cell Lung Cancer
Clin. Cancer Res., September 15, 2004; 10(18): 6006 - 6012.
[Abstract] [Full Text] [PDF]


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Clin. Cancer Res.Home page
Z. Chen, X. Zhang, M. Li, Z. Wang, H. S. Wieand, J. R. Grandis, and D. M. Shin
Simultaneously Targeting Epidermal Growth Factor Receptor Tyrosine Kinase and Cyclooxygenase-2, an Efficient Approach to Inhibition of Squamous Cell Carcinoma of the Head and Neck
Clin. Cancer Res., September 1, 2004; 10(17): 5930 - 5939.
[Abstract] [Full Text] [PDF]


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JCOHome page
E. E.W. Cohen, M. W. Lingen, and E. E. Vokes
The Expanding Role of Systemic Therapy in Head and Neck Cancer
J. Clin. Oncol., May 1, 2004; 22(9): 1743 - 1752.
[Abstract] [Full Text] [PDF]



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