title: A randomized, phase II study of afatinib versus cetuximab in metastatic or recurrent squamous cell carcinoma of the head and neck.
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 antitumor activity compared with cetuximab in recurrent or metastatic (R/M) head and neck squamous cell carcinoma (HNSCC) patients, whose disease has progressed after platinum-containing therapy.
  
  
  METHODS
  An open-label, randomized, phase II trial was conducted in 43 centers; 124 patients were randomized (1 : 1) to either afatinib (50 mg/day) or cetuximab (250 mg/m(2)/week) until disease progression or intolerable adverse events (AEs) (stage I), with optional crossover (stage II). The primary end point 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.
  
  
  CONCLUSIONS
  Afatinib showed antitumor activity comparable to cetuximab in R/M HNSCC in this exploratory phase II 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.
authors.affiliation: Department of Medicine, University of Chicago Medical Centre, Chicago, USA. Electronic address: tseiwert@medicine.bsd.uchicago.edu.
authors.forename: T Y
authors.initials: TY
authors.lastname: Seiwert
authors.affiliation: Department of Medicine, Université de Lyon, Lyon.
authors.forename: J
authors.initials: J
authors.lastname: Fayette
authors.affiliation: Institut du Cancer de Montpellier Val d'Aurelle, Montpellier, France.
authors.forename: D
authors.initials: D
authors.lastname: Cupissol
authors.affiliation: Department of Medical Oncology, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Del Campo
authors.affiliation: Division of Oncology, KU Leuven, Leuven, Belgium.
authors.forename: P M
authors.initials: PM
authors.lastname: Clement
authors.affiliation: Centro Integral Oncológico Clara Campal (CIOCC), Madrid, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Hitt
authors.affiliation: Centre Oscar Lambret, Lille, France.
authors.forename: M
authors.initials: M
authors.lastname: Degardin
authors.affiliation: Boehringer Ingelheim Shanghai Pharmaceuticals Co., Ltd, Shanghai, China.
authors.forename: W
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, USA.
authors.forename: A
authors.initials: A
authors.lastname: Blackman
authors.affiliation: Boehringer Ingelheim Danmark A/S, Copenhagen, Denmark.
authors.forename: E
authors.initials: E
authors.lastname: Ehrnrooth
authors.affiliation: Department of Medicine, University of California San Diego Moores Cancer Center, La Jolla, USA.
authors.forename: E E W
authors.initials: EEW
authors.lastname: Cohen
mesh_terms: D000328:Adult; D000077716:Afatinib; D000368:Aged; D000369:Aged, 80 and over; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy*; D000068818:Cetuximab; D066246:ErbB Receptors / Q000037:antagonists & inhibitors; D005260:Female; D006258:Head and Neck Neoplasms / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011799:Quinazolines / Q000009:adverse effects / Q000627:therapeutic use*; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000037:antagonists & inhibitors; D000077195:Squamous Cell Carcinoma of Head and Neck; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000077716:Afatinib; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D000068818:Cetuximab; D066246:ErbB Receptors; D011799:Quinazolines; D018719:Erb-b2 Receptor Tyrosine Kinases; C512478:EGFR protein, human; C508053:ERBB2 protein, human
keywords: EGFR inhibitor therapy; afatinib; cetuximab; metastatic HNSCC; recurrent HNSCC