Radiation Therapy With Cisplatin, Docetaxel, or Cetuximab After Surgery in Treating Patients With Stage III-IV Squamous Cell Head and Neck Cancer
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Purpose
This randomized phase II/III trial studies how well radiation therapy works when given together with cisplatin compared to docetaxel or cetuximab and docetaxel after surgery in treating patients with stage III-IV squamous cell head and neck cancer. Specialized radiation therapy that delivers a high dose of radiation directly to the tumor may kill more tumor cells and cause less damage to normal tissue. Drugs used in chemotherapy, such as cisplatin and docetaxel, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Monoclonal antibodies, such as cetuximab, 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 transmit tumor killing molecules to them. It is not yet known whether radiation therapy is more effective when given with cisplatin, docetaxel, or cetuximab and docetaxel.
| Condition | Intervention | Phase |
|---|---|---|
|
Recurrent Metastatic Squamous Neck Cancer With Occult Primary Recurrent Salivary Gland Cancer Recurrent Squamous Cell Carcinoma of the Hypopharynx Recurrent Squamous Cell Carcinoma of the Larynx Recurrent Squamous Cell Carcinoma of the Lip and Oral Cavity Recurrent Squamous Cell Carcinoma of the Oropharynx Recurrent Verrucous Carcinoma of the Larynx Recurrent Verrucous Carcinoma of the Oral Cavity Salivary Gland Squamous Cell Carcinoma Stage III Salivary Gland Cancer Stage III Squamous Cell Carcinoma of the Hypopharynx Stage III Squamous Cell Carcinoma of the Larynx Stage III Squamous Cell Carcinoma of the Lip and Oral Cavity Stage III Squamous Cell Carcinoma of the Oropharynx Stage III Verrucous Carcinoma of the Larynx Stage III Verrucous Carcinoma of the Oral Cavity Stage IV Squamous Cell Carcinoma of the Hypopharynx Stage IVA Salivary Gland Cancer Stage IVA Squamous Cell Carcinoma of the Larynx Stage IVA Squamous Cell Carcinoma of the Lip and Oral Cavity Stage IVA Squamous Cell Carcinoma of the Oropharynx Stage IVA Verrucous Carcinoma of the Larynx Stage IVA Verrucous Carcinoma of the Oral Cavity Stage IVB Salivary Gland Cancer Stage IVB Squamous Cell Carcinoma of the Larynx Stage IVB Squamous Cell Carcinoma of the Lip and Oral Cavity Stage IVB Squamous Cell Carcinoma of the Oropharynx Stage IVB Verrucous Carcinoma of the Larynx Stage IVB Verrucous Carcinoma of the Oral Cavity Tongue Cancer |
Drug: cisplatin Drug: docetaxel Biological: cetuximab Other: laboratory biomarker analysis Procedure: quality-of-life assessment Radiation: intensity-modulated radiation therapy |
Phase 2 Phase 3 |
| Study Type: | Interventional |
| Study Design: | Allocation: Randomized Endpoint Classification: Efficacy Study Intervention Model: Parallel Assignment Masking: Open Label Primary Purpose: Treatment |
| Official Title: | Randomized Phase II/III Trial of Surgery and Postoperative Radiation Delivered With Concurrent Cisplatin Versus Docetaxel Versus Docetaxel and Cetuximab for High-Risk Squamous Cell Cancer of the Head and Neck |
- Disease-free survival (DFS) (Phase II) [ Time Frame: Up to 8 years ] [ Designated as safety issue: No ]Estimated using the Kaplan-Meier method for each arm. Their distributions will be compared between treatment arms with a one-sided log rank test.
- Overall survival (OS) (Phase III) [ Time Frame: Up to 8 years ] [ Designated as safety issue: No ]Estimated using the Kaplan-Meier method for each arm. Their distributions will be compared between treatment arms with a one-sided log rank test.
- Local-regional failure (LRF) [ Time Frame: Within 1 week of treatment ] [ Designated as safety issue: No ]The cumulative incidence method will be used to estimate LRF and DM rates. Multivariate analysis will be performed using the Cox proportional hazards model.
- Distant metastasis (DM) [ Time Frame: Up to 8 years ] [ Designated as safety issue: No ]The cumulative incidence method will be used to estimate LRF and DM rates. Multivariate analysis will be performed using the Cox proportional hazards model.
- Patterns of cancer failure (local, regional, distant) [ Time Frame: Up to 8 years ] [ Designated as safety issue: No ]Failure rates for the experimental treatment will be compared against the control using a failure specific log rank test.
- Acute toxicity profiles during and at completion of treatment, graded according to the National Cancer Institute (NCI) CTCAE version 4.0 [ Time Frame: Up to 7 weeks ] [ Designated as safety issue: Yes ]These rates will be estimated using a binomial distribution along with their associated 95% confidence intervals and will be compared using Fisher's exact test between the treatment arms.
- Late toxicity profiles, graded according to the NCI CTCAE version 4.0 [ Time Frame: Up to 5 years ] [ Designated as safety issue: Yes ]These rates will be estimated using a binomial distribution along with their associated 95% confidence intervals and will be compared using Fisher's exact test between the treatment arms.
- Functional Assessment of Cancer Therapy-Head & Neck (FACT-H&N) scores [ Time Frame: Up to 12 months after completion of RT ] [ Designated as safety issue: No ]The effect of acute mucosal toxicity on swallowing dysfunction and global QOL will be modeled using general linear regression. Binary outcomes will be compared using Fisher's Exact test and modeled using logistic regression.
- MD Anderson Symptom Inventory - Head & Neck (MDASI-HN) scores [ Time Frame: Up to 24 months after completion of RT ] [ Designated as safety issue: No ]The effect of acute mucosal toxicity on swallowing dysfunction and global QOL will be modeled using general linear regression. Binary outcomes will be compared using Fisher's Exact test and modeled using logistic regression.
- MD Anderson Dysphagia Inventory (MDADI) scores [ Time Frame: Up to 24 months after completion of RT ] [ Designated as safety issue: No ]The effect of acute mucosal toxicity on swallowing dysfunction and global QOL will be modeled using general linear regression. Binary outcomes will be compared using Fisher's Exact test and modeled using logistic regression.
- EuroQol (EQ-5D) scores [ Time Frame: Up to 24 months after completion of RT ] [ Designated as safety issue: No ]The effect of acute mucosal toxicity on swallowing dysfunction and global QOL will be modeled using general linear regression. Binary outcomes will be compared using Fisher's Exact test and modeled using logistic regression.
- Quality adjusted life year (QALY) [ Time Frame: Up to 8 years ] [ Designated as safety issue: No ]The effect of acute mucosal toxicity on swallowing dysfunction and global QOL will be modeled using general linear regression. Binary outcomes will be compared using Fisher's Exact test and modeled using logistic regression.
- Translational research analysis [ Time Frame: Up to 8 years ] [ Designated as safety issue: No ]The mean change from completion of chemoradiation at each time point will be summarized using mean and standard deviations for each arm. Overall score and mean change from completion of chemoradiation will be compared between the arms using a two sample t test. Mean change from completion of chemoradiation will be tested using an omnibus F test followed by individual comparisons of change scores at different time points within each treatment group.
| Estimated Enrollment: | 675 |
| Study Start Date: | March 2013 |
| Estimated Primary Completion Date: | May 2020 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
|
Experimental: Arm 1 (IMRT, cisplatin)
Patients undergo IMRT QD five days a week and receive cisplatin IV over 1-2 hours once weekly for 6 weeks.
|
Drug: cisplatin
Given IV
Other Names:
Other: laboratory biomarker analysis
Correlative studies
Procedure: quality-of-life assessment
Ancillary studies
Other Name: quality of life assessment
Radiation: intensity-modulated radiation therapy
Undergo IMRT
Other Name: IMRT
|
|
Experimental: Arm 2 (IMRT, docetaxel)
Patients undergo IMRT as in Arm I and receive docetaxel IV once weekly for 6 weeks.
|
Drug: docetaxel
Given IV
Other Names:
Other: laboratory biomarker analysis
Correlative studies
Procedure: quality-of-life assessment
Ancillary studies
Other Name: quality of life assessment
Radiation: intensity-modulated radiation therapy
Undergo IMRT
Other Name: IMRT
|
|
Experimental: Arm 3 (IMRT, docetaxel, cetuximab)
Patients receive cetuximab IV over 120 minutes on week 1 and over 60 minutes once weekly on weeks 2-7. Patients undergo IMRT as in Arm I and receive docetaxel once weekly for 6 weeks.
|
Drug: docetaxel
Given IV
Other Names:
Biological: cetuximab
Given IV
Other Names:
Other: laboratory biomarker analysis
Correlative studies
Procedure: quality-of-life assessment
Ancillary studies
Other Name: quality of life assessment
Radiation: intensity-modulated radiation therapy
Undergo IMRT
Other Name: IMRT
|
Detailed Description:
PRIMARY OBJECTIVES:
I. To select the better experimental arm to improve disease-free survival (DFS) over the control arm of radiation and cisplatin. (Phase II) II. To determine whether the selected experimental arm will improve overall survival (OS) over the control arm of radiation and cisplatin. (Phase III)
SECONDARY OBJECTIVES:
I. To improve local-regional disease control. II. To compare distant metastasis. III. To compare patterns of cancer failure (local, regional, distant) and correlate with radiation dose and technique.
IV. To compare acute toxicity profiles during radiation therapy (RT) and at completion of treatment.
V. To compare late toxicity profiles at 1, 3, and 5 years after treatment. VI. To compare overall quality of life. VII. To compare patient-reported outcome. VIII. To compare swallowing function at 1 and 2 years. IX. To investigate associations between acute mucosal toxicity, swallowing function, and quality of life (QOL).
X. To compare quality adjusted life years (QALY). XI. To investigate associations between late toxicity (dysphagia) and QALY. XII. To determine whether specific molecular profiles are associated with clinical outcomes.
OUTLINE: Patients are randomized to 1 of 3 treatment groups.
ARM 1: Patients undergo intensity modulated radiation therapy (IMRT) once daily (QD) five days a week and receive cisplatin intravenously (IV) over 1-2 hours once weekly for 6 weeks.
ARM 2: Patients undergo IMRT as in Arm I and receive docetaxel IV once weekly for 6 weeks.
ARM 3: Patients receive cetuximab IV over 120 minutes on week 1 and over 60 minutes once weekly on weeks 2-7. Patients undergo IMRT as in Arm I and receive docetaxel once weekly for 6 weeks.
After completion of study treatment, patients are followed up at 1 and 3 months, every 3 months for 2 years, every 6 months for 3 years, and then annually thereafter.
Eligibility| Ages Eligible for Study: | 18 Years and older |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Pathologically (histologically or cytologically) proven diagnosis of head and neck squamous cell carcinoma (HNSCC) involving the oral cavity, oropharynx (p16 negative), larynx, or hypopharynx within 49 days of registration
- Patients must have undergone gross total surgical resection of high-risk oral cavity, oropharynx (p16 negative), larynx, or hypopharynx within 49 days prior to registration
- Patients must have at least 1 of the following high-risk pathologic features: extracapsular nodal extension or invasive cancer seen within 3 mm of the primary tumor resection margins
Pathologic stage III or IV head and neck squamous cell carcinoma (HNSCC), including no distant metastases, based upon the following minimum diagnostic workup:
- General history and physical examination by a radiation oncologist and/or medical oncologist within 56 days prior to registration;
- Examination by an ear nose throat (ENT) or head & neck surgeon, within 56 days prior to registration; a laryngopharyngoscopy (mirror and/or fiber optic and/or direct procedure) is recommended but not required.
- Pre-op Imaging within 63 days of registration: Either a computed tomography (CT) (with contrast) or CT/positron emission tomography (PET) (with contrast) and/or an magnetic resonance imaging (MRI) (T1 with gadolinium and T2) of the head and neck within 63 days prior to registration; note: this imaging data (diagnostic pre-operative scan showing gross disease) is to be submitted on a compact disk (CD) in Digital Imaging and Communications in Medicine (DICOM) format to Radiation Therapy Oncology Group (RTOG) Headquarters with the report
- Chest CT scan (with or without contrast) or CT/PET of chest (with or without contrast) within 56 days prior to registration
- Zubrod performance status of 0-1 within 14 days prior to registration
- Absolute granulocyte count (AGC) >= 1,500 cells/mm^3
- Platelets >= 100,000 cells/mm^3
- Hemoglobin >= 8.0 g/dl (Note: The use of transfusion or other intervention to achieve hemoglobin [Hgb] >= 8.0 g/dl is acceptable)
- Total bilirubin < 2 x institutional upper limit of normal (ULN) within 14 days prior to registration
- Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) < 3 x institutional ULN within 14 days prior to registration
- Serum creatinine institutional ULN within 14 days prior to registration or; creatinine clearance (CC) >= 50 ml/min within 14 days prior to registration determined by 24-hour collection or estimated by Cockcroft-Gault formula
- Negative serum pregnancy test within 14 days prior to registration for women of childbearing potential
- The following assessments are required within 14 days prior to registration: sodium (Na), potassium (K), chloride (Cl), glucose, calcium (Ca), magnesium (Mg), and albumin; Note: Patients with an initial magnesium < 0.5 mmol/L (1.2 mg/dl) may receive corrective magnesium supplementation but should continue to receive either prophylactic weekly infusion of magnesium and/or oral magnesium supplementation (eg, magnesium oxide) at the investigator's discretion
- Patients with feeding tubes are eligible for the study
- Women of childbearing potential and male participants who are sexually active must agree to use a medically effective means of birth control
- Patient must provide study specific informed consent prior to study entry, including consent for mandatory tissue submission for epidermal growth factor receptor (EGFR) analysis and for oropharyngeal cancer patients, human papilloma virus (HPV) analysis
Exclusion Criteria:
- Prior invasive malignancy (except non-melanomatous skin cancer) unless disease free for a minimum of 1095 days (3 years); noninvasive cancers (for example, carcinoma in situ of the breast, oral cavity, or cervix are all permissible) are permitted even if diagnosed and treated < 3 years ago
- Patients with simultaneous primaries or bilateral tumors are excluded, with the exception of patients with bilateral tonsil cancers or patients with T1-2, N0, M0 resected differentiated thyroid carcinoma, who are eligible
- Prior systemic chemotherapy or anti-epidermal growth factor (EGF) therapy for the study cancer; note that prior chemotherapy for a different cancer is allowable
- Prior radiotherapy to the region of the study cancer that would result in overlap of radiation therapy fields
Severe, active co-morbidity, defined as follows:
- Unstable angina and/or congestive heart failure requiring hospitalization within 6 months prior to registration
- Transmural myocardial infarction within 6 months prior to registration
- Acute bacterial or fungal infection requiring intravenous antibiotics at the time of registration
- Chronic obstructive pulmonary disease exacerbation or other respiratory illness requiring hospitalization or precluding study therapy at the time of registration
- Idiopathic pulmonary fibrosis or other severe interstitial lung disease that requires oxygen therapy or is thought to require oxygen therapy within 1 year prior to registration
- Hepatic insufficiency resulting in clinical jaundice and/or coagulation defects; note, however, that laboratory tests for coagulation parameters are not required for entry into this protocol
- Acquired immune deficiency syndrome (AIDS) based upon current Centers for Disease and Control (CDC) definition; note: HIV testing is not required for entry into this protocol; the need to exclude patients with AIDS from this protocol is necessary because the treatments involved in this protocol may be significantly immunosuppressive; protocol-specific requirements may also exclude immuno-compromised patients
- Grade 3-4 electrolyte abnormalities (Common Terminology Criteria for Adverse Events [CTCAE], v. 4):
- Serum calcium (ionized or adjusted for albumin) < 7 mg/dl (1.75 mmol/L) or > 12.5 mg/dl (> 3.1 mmol/L) despite intervention to normalize levels
- Glucose < 40 mg/dl (< 2.2 mmol/L) or > 250 mg/dl (> 14mmol/L)
- Magnesium < 0.9 mg/dl (< 0.4 mmol/L) or > 3 mg/dl (> 1.23 mmol/L) despite intervention to normalize levels
- Potassium < 3.5 mmol/L or > 6 mmol/L despite intervention to normalize levels
- Sodium < 130 mmol/L or > 155 mmol/L despite intervention to normalize levels
- Pregnancy or women of childbearing potential and men who are sexually active and not willing/able to use medically acceptable forms of contraception; this exclusion is necessary because the treatment involved in this study may be significantly teratogenic
- Prior allergic reaction to cetuximab
Contacts and Locations| United States, California | |
| Stanford University Medical Center | Recruiting |
| Stanford, California, United States, 94305 | |
| Contact: Quynh-Thu Le, MD qle@stanford.edu | |
| United States, Wisconsin | |
| University of Wisconsin Hospital | Not yet recruiting |
| Madison, Wisconsin, United States, 56792 | |
| Contact: Paul M. Harari 608-263-8500 harari@humonc.wisc.edu | |
| Principal Investigator: Paul M. Harari | |
| Principal Investigator: | Paul Harari | Radiation Therapy Oncology Group |
More Information
No publications provided
| Responsible Party: | Radiation Therapy Oncology Group |
| ClinicalTrials.gov Identifier: | NCT01810913 History of Changes |
| Other Study ID Numbers: | RTOG 1216, NCI-2013-00500, U10CA021661 |
| Study First Received: | March 12, 2013 |
| Last Updated: | March 12, 2013 |
| Health Authority: | United States: Food and Drug Administration |
Additional relevant MeSH terms:
|
Oropharyngeal Neoplasms Carcinoma Carcinoma, Squamous Cell Neoplasms, Squamous Cell Head and Neck Neoplasms Laryngeal Diseases Tongue Neoplasms Carcinoma, Verrucous Neoplasms, Unknown Primary Salivary Gland Neoplasms Hypopharyngeal Neoplasms Laryngeal Neoplasms Neoplasms, Glandular and Epithelial Neoplasms by Histologic Type Neoplasms |
Neoplasms by Site Respiratory Tract Diseases Otorhinolaryngologic Diseases Mouth Neoplasms Mouth Diseases Stomatognathic Diseases Tongue Diseases Neoplasm Metastasis Neoplastic Processes Pathologic Processes Salivary Gland Diseases Pharyngeal Neoplasms Otorhinolaryngologic Neoplasms Pharyngeal Diseases Respiratory Tract Neoplasms |
ClinicalTrials.gov processed this record on June 17, 2013