RATIONALE: Erlotinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Monoclonal antibodies, such as cetuximab and bevacizumab, can block tumor growth in different ways. Some block the ability of tumor cells to grow and spread. Others find tumor cells and help kill them or carry tumor-killing substances to them. Cetuximab and bevacizumab may also stop the growth of tumor cells by blocking blood flow to the tumor. Giving erlotinib together with cetuximab and/or bevacizumab may kill more tumor cells.

PURPOSE: This randomized phase I/II trial is studying the side effects, best way to give, and best dose of erlotinib and bevacizumab when given with cetuximab and how well giving erlotinib and cetuximab together with or without bevacizumab works in treating patients with metastatic or unresectable kidney, colorectal, head and neck, or non-small cell lung cancer.

Condition	Treatment or Intervention	Phase
Gastrointestinal Cancer Head and Neck Cancer kidney and urinary cancer thorax and respiratory cancer	Drug: bevacizumab  Drug: cetuximab  Drug: erlotinib  Procedure: anti-cytokine therapy  Procedure: antiangiogenesis therapy  Procedure: antibody therapy  Procedure: biological response modifier therapy  Procedure: enzyme inhibitor therapy  Procedure: growth factor antagonist therapy  Procedure: monoclonal antibody therapy  Procedure: protein tyrosine kinase inhibitor therapy	Phase I Phase II

Further Study Details: 

OBJECTIVES: Primary

• Determine the maximum tolerated dose (MTD) of erlotinib when combined with cetuximab in patients with metastatic or unresectable renal cell, colorectal, head and neck, or non-small cell lung cancer (phase I, part 1).
• Determine the MTD of bevacizumab when combined with cetuximab and erlotinib in these patients (phase I, part 2).
• Determine the toxic effects, both quantitatively and qualitatively, of these regimens in these patients.
• Determine the antitumor activity of these regimens, in terms of tumor response, short-term survival, and progression-free survival, in these patients.

Secondary

• Compare, preliminarily, the toxicity and antitumor activity profiles of these regimens in these patients.

OUTLINE: This is an open-label, two-part, phase I, multicenter, dose-escalation study of erlotinib and bevacizumab followed by a randomized, phase II study.

• Patients receive oral erlotinib once daily on days 1-28. Patients also receive cetuximab IV over 3 hours on day 1 and over 1 hour on days 8, 15, and 22. Cohorts of 3-6 patients receive escalating doses of erlotinib until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity.
• Patients receive erlotinib as in part 1 at the MTD and cetuximab as in part 1. Patients also receive bevacizumab IV over 1½ hours on day 1 and over 1 hour on day 15. Cohorts of 3-6 patients receive escalating doses of bevacizumab until the MTD is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity.

In both groups, courses repeat every 28 days in the absence of unacceptable toxicity or disease progression.

• Patients who are able to undergo biopsy are randomized to 1 of 3 treatment arms (arm II, III, or IV). Patients who are unable to undergo biopsy are assigned to arm I.
• Arm I: Patients receive erlotinib as in phase I at the MTD and cetuximab as in phase I.
• Arm II: Patients receive erlotinib as in phase I at the MTD and cetuximab IV over 3 hours on day 15 and over 1 hour on day 22.
• Arm III: Patients receive oral erlotinib once daily on days 15-28 and cetuximab as in phase I .
• Arm IV: Patients receive erlotinib and bevacizumab as in phase I at the MTD and cetuximab as in phase I. In all arms, courses repeat every 28 days in the absence of unacceptable toxicity or disease progression.

Patients are followed at 1 month and then every 2 months thereafter.

PROJECTED ACCRUAL: A total of 37-70 patients (6-9 for phase I, part 1, 6-9 for phase I, part 2, and 25-52 for phase II) will be accrued within 12-18 months.

Ages Eligible for Study:  18 Years and above,  Genders Eligible for Study:  Both

Criteria

DISEASE CHARACTERISTICS:

• One of the following histologically confirmed diagnoses:
• Renal cell cancer (phase I and II)
• Clear cell histology
• Metastatic or unresectable disease AND meets 1 of the following criteria:
• Recurrent disease
• Refractory to interleukin-2 (IL-2)- or interferon-based therapy
• Previously untreated AND not a candidate for IL-2-based therapy
• Colorectal, head and neck, or non-small cell lung cancer (phase I only)
• Metastatic or unresectable disease
• Progression after prior standard treatment
• Measurable disease (phase II only)
• At least 1 unidimensional lesion > 20 mm by conventional techniques OR > 10 mm by spiral CT scan
• No evidence of CNS disease, including the following (phase I, part 2 and phase II only):
• Primary brain tumor
• Brain metastases
• Paraffin embedded tumor blocks available

PATIENT CHARACTERISTICS: Age

• 18 and over

Performance status

• ECOG 0-2 OR
• Karnofsky 60-100%

Life expectancy

• More than 12 weeks

Hematopoietic

• Absolute neutrophil count ≥ 1,500 mm^3
• Platelet count ≥ 100,000 mm^3

Hepatic

• Bilirubin ≤ 1.5 mg/dL
• AST and ALT ≤ 2.5 times upper limit of normal (ULN) (5 times ULN if liver metastasis is present)
• PTT and INR ≤ 1.5, unless receiving full-dose warfarin (phase I, part 2 and phase II only)

Renal

• Creatinine ≤ 1.5 times ULN OR
• Creatinine clearance ≥ 60 mL/min
• Calcium < 10 mg/dL (hypocalcemic agents allowed)
• No proteinuria* OR
• Protein < 1 g on 24-hour urine collection* NOTE: *For patients enrolled in phase I, part 2 or phase II only

Cardiovascular

• No unstable angina pectoris
• No cardiac arrhythmia
• No symptomatic congestive heart failure
• None of the following are allowed for phase I, part 2 or phase II:
• Myocardial infarction within the past 6 months
• New York Heart Association class II-IV heart disease
• Serious cardiac arryhthmia requiring medication
• Peripheral vascular disease ≥ grade II
• Recent history of cerebrovascular accident
• Uncontrolled hypertension (blood pressure ≥ 150/85 mm Hg despite medication)
• Other clinically significant cardiovascular disease

Gastrointestinal

• No gastrointestinal (GI) tract disease resulting in an inability to take oral medication
• No GI tract disease resulting in a requirement for IV alimentation
• No active peptic ulcer disease

Immunologic

• No history of allergic reaction attributed to compounds of similar chemical or biologic composition to study drugs
• No known hypersensitivity to Chinese hamster ovary cell products or other recombinant human antibodies (phase I, part 2 and phase II only)
• No ongoing or active infection
• No active infection requiring parenteral antibiotics (phase I, part 2 and phase II only)

Other

• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception during and for 2 months after study treatment
• No significant traumatic injury within the past 28 days (phase I, part 2 and phase II only)
• No history of abnormalities of the cornea (e.g., dry eye syndrome, Sjögren's syndrome, or congenital abnormality [e.g., Fuch's dystrophy])
• No other malignancy within the past 3 years except nonmelanoma skin cancer or carcinoma in situ of the breast or cervix
• No psychiatric illness or social situation that would preclude study compliance
• No serious or non-healing wound ulcer or bone fracture (phase I, part 2 and phase II only)
• No other uncontrolled illness

PRIOR CONCURRENT THERAPY: Biologic therapy

• See Disease Characteristics
• More than 4 weeks since prior immunotherapy
• No prior cetuximab
• No prior bevacizumab
• Concurrent epoetin alfa or darbepoetin alfa allowed

Chemotherapy

• More than 4 weeks since prior chemotherapy (6 weeks for nitrosoureas or mitomycin)

Endocrine therapy

• Not specified

Radiotherapy

• More than 4 weeks since prior radiotherapy

Surgery

• No prior surgical procedures affecting absorption
• Prior nephrectomy or resection of metastatic lesions allowed provided patient has fully recovered
• More than 7 days since prior core biopsy*
• More than 28 days since prior major surgery or open biopsy*
• No concurrent major surgery* NOTE: *For patients enrolled in phase I, part 2 and phase II only

Other

• Recovered from all prior therapy
• No prior erlotinib
• Concurrent bisphosphonates allowed
• Concurrent full-dose anticoagulants allowed provided the following criteria are met (phase I, part 2 and phase II only):
• In-range INR (usually between 2 and 3) AND on a stable dose of warfarin or low molecular weight heparin
• No active bleeding
• No pathological conditions that carry a high risk of bleeding (e.g., tumor involving major vessels or varices)
• No other concurrent investigational agents
• No concurrent combination antiretroviral therapy for HIV-positive patients
• No other concurrent anticancer therapy

Texas
      Brooke Army Medical Center, Fort Sam Houston,  Texas,  78234-6200,  United States; Recruiting
      Institute for Drug Development, San Antonio,  Texas,  78229,  United States; Recruiting
      Veterans Affairs Medical Center - San Antonio (Murphy), San Antonio,  Texas,  78229,  United States; Recruiting

Study chairs or principal investigators

Anthony W. Tolcher, MD,  Study Chair,  Institute for Drug Development   

Study ID Numbers:  CDR0000401514; CTRC-IDD-0332; NCI-6588; NCT00101348
Record last reviewed:  January 2005
Last Updated:  February 4, 2005
Record first received:  January 7, 2005
ClinicalTrials.gov Identifier:  NCT00101348
Health Authority: United States: Federal Government
ClinicalTrials.gov processed this record on 2005-04-08