Trial of Induction Chemotherapy With Carboplatin and Paclitaxel, Followed by Concurrent Chemotherapy/Radiation Therapy With ZD1839 (IRESSA), 5-FU, Hydroxyurea, and Twice-Daily Radiation, Followed by Adjuvant ZD1839 Monotherapy in Patients With Locally Advanced Head & Neck Cancer

Inclusion criteria

• Histologically or cytologically confirmed diagnosis of squamous cell or poorly differentiated carcinomas, or lymphoepithelioma of the nasopharynx.
• Age 18 years or older.
• Patients with AJCC (6th edition, 2002) stage III or IV head and neck cancer.
• Patients with AJCC (6th edition, 2002) stage IV head and neck cancer. presenting with cervical lymph node metastasis of an unknown primary (i.e., TxN2 or TxN3) are also eligible.
• Prior to entry in the study, the resectability and alternative treatment options for each patient will be determined by a team composed of a head and neck surgeon, a radiation oncologist,and a medical oncologist. Stage determination, optimal local treatment, and its timing according to this protocol will be determined at this evaluation. Each patient will be classified as having resectable or unresectable disease. The unequivocal demonstration of distant metastasis (M1) confers ineligibility.
• Unidimensionally measurable disease (based on RECIST) is desirable but not strictly required. Individuals who are disease free at baseline after excisional biopsy or node dissection will be considered not evaluable for response assessment but are eligible.
• No prior or radiotherapy.
• Prior surgical therapy will consist only of incisional or excisional biopsy and organ-sparing procedures such as debulking of airway-compromising tumors or neck dissection in a patient with an unknown primary tumor.
• Eastern Cooperative Oncology Group (ECOG) performance status ≤ 2 (Karnofsky ≥ 60%.
• Patients must have normal organ and marrow function as defined below absolute neutrophil count (ANC) ≥ 1,500/μl platelets ≥ 100,000/μl total bilirubin within normal institutional limits aspartate aminotransferase (AST, SGOT)/ alanine aminotransferase (ALT, SGPT) ≤ 2.5 × institutional upper limit of normal alkaline phosphatase ≤ 2 × upper limit of normal creatinine within normal institutional limits

Exclusion criteria

• Unequivocal demonstration of metastatic disease (i.e. M1 disease).
• Known severe hypersensitivity to ZD1839 or any of the excipients of this product.
• Any coexisting malignancy that would increase risk of toxicity, interfere with interpretation of toxicity, or is associated with a median survival of less than 24 months.
• Concomitant use of phenytoin, carbamazepine, barbiturates, rifampin, phenobarbital, or St.John's Wort.
• Treatment with an investigational drug within 30 days before Day 1 of trial treatment.
• Incomplete healing from previous surgery.
• Pregnancy or breast feeding (women of child-bearing potential). Patients should be advised to use effective contraception as appropriate.
• History of allergic reactions attributed to compounds of similar chemical or biologic composition to paclitaxel, Cremophor EL, carboplatin, 5 FU, or hydroxyurea.
• Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection,symptomatic congestive heart failure (CHF), unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements.
• Patients with clinically significant pulmonary dysfunction, cardiomyopathy, or any history of clinically significant CHF are excluded. The exclusion of patients with active coronary artery disease will be at the discretion of the attending physician.
• Patients must have no uncontrolled active infection other than that not curable without treatment of their cancer.
• No patients with severe baseline neurologic deficits (> grade II neuropathy) will be treated with induction chemotherapy.
• Any evidence of clinically active interstitial lung disease (patients with chronic stable radiographic changes who are asymptomatic need not be excluded.