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Docetaxel Based Chemotherapy Plus or Minus Induction Chemotherapy to Decrease Events in Head and Neck Cancer (DeCIDE) (DeCIDE)

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ClinicalTrials.gov Identifier: NCT00117572
Recruitment Status : Completed
First Posted : July 7, 2005
Results First Posted : April 9, 2018
Last Update Posted : April 9, 2018
Sponsor:
Information provided by (Responsible Party):
University of Chicago

Brief Summary:
The combined use of chemotherapeutic drugs with radiation has proven to be effective in improving overall survival and local control among patients with locally advanced head and neck cancer. Induction chemotherapy given before receiving local treatment has been shown to reduce the rate of distant failure. Many drugs have been found to prevent tumor cells from growing or dividing, although it has yet to be determined which agent, or specific combination of agents, is most effective in treating head and neck cancer. Docetaxel is a drug which has been reported to show promising activity in Phase II head and neck cancer studies. Therefore, the purpose of this trial is to compare the effectiveness of induction chemotherapy followed by chemoradiotherapy versus the same chemoradiotherapy alone in patients with locally advanced head and neck cancer.

Condition or disease Intervention/treatment Phase
Cancer of the Pharynx Cancer of the Larynx Cancer of the Nasal Cavity Paranasal Sinus Neoplasms Cancer of the Oral Cavity Drug: docetaxel Drug: cisplatin Drug: hydroxyurea Drug: fluorouracil Procedure: chemotherapy Procedure: radiotherapy Phase 3

Detailed Description:

TRIAL DESIGN:

Phase III trial of induction therapy with docetaxel followed by chemoradiotherapy versus chemoradiotherapy alone in patients with nodal stage N2 or N3 head and neck cancer

OBJECTIVES:

Primary

  • To determine the effect on overall survival when induction chemotherapy is administered prior to chemoradiotherapy in patients with N2 or N3 disease.

Secondary

  • To determine the effect of induction chemotherapy when administered prior to chemoradiotherapy on distant failure-free survival, failure pattern, progression free survival and quality of life.

TREATMENT PLAN:

  • After eligibility is confirmed, patients will be randomized to one of two treatment arms:

Arm A - Induction + chemoradiotherapy

Arm B - Chemoradiotherapy alone

  • Induction therapy: Two 21-day cycles of chemotherapy consisting of docetaxel (day 1), cisplatin (day 1), and 5-fluorouracil (days 1-5). Total duration of 6 weeks.
  • Chemoradiotherapy: Five 14-day cycles of docetaxel (day 1), 5-fluorouracil (day 0-4), and hydroxyurea (days 0-4) with twice daily radiation (days 1-5). Total duration of 10 weeks.
  • All patients will undergo surgical evaluation after chemoradiation for possible neck dissection.
  • Upon completion of treatment, patients will be monitored every three months during the first year, every six months during the second and third years, and annually thereafter, up to seven years.
  • Patients will be followed for Quality of Life (QOL) during the course of treatment, as well as annually thereafter, up to five years.

PROJECTED ACCRUAL:

  • An expected sample size of 400 patients will be enrolled for this study (200 per treatment arm).

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 285 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Phase III Randomized Trial of Docetaxel Based Induction Chemotherapy in Patients With N2/N3 Locally Advanced Head and Neck Cancer
Study Start Date : November 2004
Actual Primary Completion Date : December 2016
Actual Study Completion Date : December 2016

Resource links provided by the National Library of Medicine

Drug Information available for: Docetaxel
U.S. FDA Resources

Arm Intervention/treatment
Active Comparator: Induction plus chemoradiotherapy

Induction therapy: Two 21-day cycles of chemotherapy consisting of docetaxel (75 mg/m2, day 1), cisplatin (75 mg/m2, day 1), and 5-fluorouracil (750 mg/m2/day, days 1-5). Total duration of 6 weeks.

Chemoradiotherapy: Five 14-day cycles of docetaxel (25 mg/m2, day 1), 5-fluorouracil (600 mg/m2/day, day 0-4), and hydroxyurea (500 mg PO q 12 hours x 6 days (11 doses)) with twice daily radiation (150 cGy given bid, days 1-5). Total duration of 10 weeks.

Drug: docetaxel
75 mg/m2 on day 1 (induction phase); 25 mg/m2 on day 1 (chemoradiotherapy phase)
Drug: cisplatin
75 mg/m2 on day 1
Drug: hydroxyurea
Each cycle: 500 mg PO q 12 hours x 6 days (11 doses)
Drug: fluorouracil
750 mg/m2/day on days 1-5 (induction phase); 600 mg/m2/day, day 0-4 (chemoradiotherapy phase)
Procedure: chemotherapy
See protocol for details
Procedure: radiotherapy
See protocol for details
Active Comparator: Chemoradiotherapy
Chemoradiotherapy: Five 14-day cycles of docetaxel (25 mg/m2, day 1), 5-fluorouracil (600 mg/m2/day, day 0-4), and hydroxyurea (500 mg PO q 12 hours x 6 days (11 doses)) with twice daily radiation (150 cGy given bid, days 1-5). Total duration of 10 weeks.
Drug: docetaxel
75 mg/m2 on day 1 (induction phase); 25 mg/m2 on day 1 (chemoradiotherapy phase)
Drug: hydroxyurea
Each cycle: 500 mg PO q 12 hours x 6 days (11 doses)
Drug: fluorouracil
750 mg/m2/day on days 1-5 (induction phase); 600 mg/m2/day, day 0-4 (chemoradiotherapy phase)
Procedure: chemotherapy
See protocol for details
Procedure: radiotherapy
See protocol for details



Primary Outcome Measures :
  1. Overall Survival: Time From Randomization to Death From Any Cause [ Time Frame: Up to 6 years ]
    Survival rates over 6 years.


Secondary Outcome Measures :
  1. Distant Failure-free Survival (DFFS): Time From Randomization to Distant Recurrence or Death From Any Cause [ Time Frame: Up to 6 years ]
    DFFS rates over 6 years. DFFS is time from randomization to distant recurrence or death from any cause

  2. Recurrence Free Survival: Time From Randomization to Local/Regional/Distant Recurrence or Death From Any Cause [ Time Frame: Up to 6 years ]
    Recurrence-free survival rates over 6 years. Recurrence-free survival is time from randomization to local, regional, or distant recurrence or death from any cause

  3. Failure Pattern (Local/Regional Recurrence) [ Time Frame: Up to 6 years ]
    Percentage of patients with local/regional recurrence

  4. Failure Pattern (Distant Recurrence) [ Time Frame: Up to 6 years ]
    Percentage of patients with distant recurrence

  5. Quality of Life (FACT H&N) [ Time Frame: Change from baseline to post-CRT (post-pre). This corresponds to week 16 in the induction arm and week 10 in the CRT alone arm. ]
    FACT Hand-and-neck subscale(b) (0-40 point scale with negative numbers indicating worsening of function)

  6. Quality of Life (Normalcy of Diet) [ Time Frame: Change from baseline to post-CRT (post-pre). This corresponds to week 16 in the induction arm and week 10 in the CRT alone arm. ]
    Performance Status Score (0-100 point scale with negative numbers indicating worsening of function)

  7. Quality of Life (Speech) [ Time Frame: Change from baseline to post-CRT (post-pre). This corresponds to week 16 in the induction arm and week 10 in the CRT alone arm. ]
    Performance Status Score (0-100 point scale with negative numbers indicating worsening of function)

  8. Quality of Life (McMaster) [ Time Frame: Change from baseline to post-CRT (post-pre). This corresponds to week 16 in the induction arm and week 10 in the CRT alone arm. ]
    McMaster RT Questionnaire (4-28 point scale with negative numbers indicating worsening of function)

  9. Quality of Life (FACT H&N) [ Time Frame: Change from baseline to 1 year (1 year-pre) ]
    FACT Hand-and-neck subscale(b) (0-40 point scale with negative numbers indicating worsening of function)

  10. Quality of Life (Normalcy of Diet) [ Time Frame: Change from baseline to 1 year (1 year-pre) ]
    Performance Status Score (0-100 point scale with negative numbers indicating worsening of function)

  11. Quality of Life (Speech) [ Time Frame: Change from baseline to 1 year (1 year-pre) ]
    Performance Status Score (0-100 point scale with negative numbers indicating worsening of function)

  12. Quality of Life (McMaster) [ Time Frame: Change from baseline to 1 year (1 year-pre) ]
    McMaster RT Questionnaire (4-28 point scale with negative numbers indicating worsening of function)



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Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Age 18 years or older
  • Histologically or cytologically confirmed diagnosis of squamous cell or poorly differentiated carcinomas of the head and neck (excluding lip), or lymphoepithelioma
  • No prior chemotherapy 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 existing primary tumor
  • Karnofsky performance status of >= 70%
  • Intact organ and bone marrow function
  • Obtained informed consent

Exclusion Criteria:

  • Demonstration of metastatic disease (i.e. M1 disease).
  • Patients with a history of severe allergic reaction to docetaxel or other drugs formulated with polysorbate 80. History of allergic reactions attributed to compounds of similar chemical or biologic composition to cisplatin, 5-fluorouracil, or hydroxyurea
  • Other coexisting malignancies or malignancies diagnosed within the previous 3 years with the exception of basal cell carcinoma, cervical cancer in situ, and other treated malignancies with no evidence of disease for at least 3 years.
  • Prior surgical therapy other than 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. Any non-biopsy procedure must have taken place less than 3 months from initiating protocol treatment.
  • Incomplete healing from previous surgery
  • Pregnancy or breast feeding (men and women of child-bearing potential are eligible but must consent to using effective contraception during therapy and for at least 3 months after completing therapy)
  • 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.
  • Uncontrolled active infection unless curable with treatment of their cancer.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00117572


  Show 26 Study Locations
Sponsors and Collaborators
University of Chicago
Investigators
Principal Investigator: Everett Vokes, M.D. University of Chicago

Responsible Party: University of Chicago
ClinicalTrials.gov Identifier: NCT00117572     History of Changes
Other Study ID Numbers: 13362B
First Posted: July 7, 2005    Key Record Dates
Results First Posted: April 9, 2018
Last Update Posted: April 9, 2018
Last Verified: April 2018

Keywords provided by University of Chicago:
Cancer of the Pharynx (Nasopharynx, Oropharynx, Hypopharynx)
Cancer of the Nasal Cavity and Paranasal Sinuses

Additional relevant MeSH terms:
Head and Neck Neoplasms
Laryngeal Neoplasms
Paranasal Sinus Neoplasms
Pharyngeal Neoplasms
Neoplasms by Site
Neoplasms
Otorhinolaryngologic Neoplasms
Laryngeal Diseases
Respiratory Tract Diseases
Respiratory Tract Neoplasms
Otorhinolaryngologic Diseases
Nose Neoplasms
Nose Diseases
Paranasal Sinus Diseases
Pharyngeal Diseases
Stomatognathic Diseases
Docetaxel
Cisplatin
Fluorouracil
Hydroxyurea
Antineoplastic Agents
Tubulin Modulators
Antimitotic Agents
Mitosis Modulators
Molecular Mechanisms of Pharmacological Action
Antimetabolites
Antimetabolites, Antineoplastic
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs