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Determination of Cetuximab Versus Cisplatin Early and Late Toxicity Events in HPV+ OPSCC (De-ESCALaTE)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01874171
Recruitment Status : Active, not recruiting
First Posted : June 10, 2013
Last Update Posted : May 8, 2017
Cancer Research UK
University of Birmingham
University of Oxford
Information provided by (Responsible Party):
Prof. Janet Dunn, University of Warwick

Brief Summary:

Oropharyngeal squamous cell carcinoma (OPSCC) incidence is increasing rapidly in the developed world. This has been attributed to a rise in Human Papillomavirus (HPV) infection. HPV+OPSCC is considered a distinct disease entity, affecting younger patients and has a good prognosis following treatment. Subsequently, patients can live with the considerable side effects for several decades.

Radiotherapy and cetuximab (Epidermal Growth Factor Receptor-inhibitor) have demonstrated similar efficacy to 'platin' chemoradiotherapy (current standard treatment containing platinum-based compounds) in head and neck cancer, but is potentially less toxic.

Results of this trial will be used to determine the optimum treatment of this debilitating cancer, with the primary aim of decreasing toxicity and improving quality of life for HPV+OPSCC patients.

Condition or disease Intervention/treatment Phase
Oropharyngeal Squamous Cell Carcinoma Drug: Cisplatin Drug: Cetuximab Phase 3

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 334 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Determination of Epidermal Growth Factor Receptor-inhibitor (Cetuximab) Versus Standard Chemotherapy (Cisplatin) Early And Late Toxicity Events in Human Papillomavirus-positive Oropharyngeal Squamous Cell Carcinoma
Actual Study Start Date : November 15, 2012
Estimated Primary Completion Date : February 2019
Estimated Study Completion Date : February 2019

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Active Comparator: Cisplatin
Three doses of cisplatin 100mg/m2 given at days 1, 22 and 43 from start of radiotherapy.
Drug: Cisplatin
Experimental: Cetuximab
Initial dose of 400mg/m2 one week before start of radiotherapy followed by seven weekly doses of 250 mg/m2 during radiotherapy.
Drug: Cetuximab

Primary Outcome Measures :
  1. Compare severe (acute and late) toxicity (Grade 3-5) caused by cetuximab and radiotherapy to that caused by cisplatin and radiotherapy. [ Time Frame: Up to two years after end of treatment. ]

Secondary Outcome Measures :
  1. Overall number of events of acute severe toxicity between treatment arms. [ Time Frame: Up to and including three months after end of treatment. ]
  2. Overall number of events of late severe toxicity between treatment arms. [ Time Frame: From three months up to two years after end of treatment. ]
  3. Quality of life outcomes assessed by EORTC QLQ C30 and HN35 between the two treatment arms. [ Time Frame: Baseline, end of treatment, and 3, 6, 12 & 24 months after end of treatment. ]
  4. Effect on swallowing of the two treatment arms (assessed by MDADI and by PEG or RIG utilisation rate at 1 and 2 years). [ Time Frame: Baseline, end of treatment, and 3, 6, 12 & 24 months after end of treatment. ]
  5. Cost-effectiveness of the two treatment arms (assessed by EuroQoL-5D). [ Time Frame: Up to two years after end of treatment. ]
    Questionnaires completed at the following time points: Baseline, end of treatment, and 3, 6, 12 & 24 months after end of treatment.

  6. Overall survival and recurrence between the two arms. [ Time Frame: Up to two years after end of treatment. ]

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

Inclusion Criteria:

  • American Joint Committee on Cancer (AJCC) TNM Stage III-IVa (T3N0-T4N0, and T1N1-T4N3) oropharyngeal squamous cell carcinoma (SCC) tumours
  • Clinical multidisciplinary team decision to treat with primary curative cisplatin chemoradiotherapy
  • No previous treatment including surgery, except node biopsies or diagnostic tonsillectomy
  • Medically fit (ECOG 0, 1 or 2)
  • Adequate cardiovascular, haematological, renal and hepatic function
  • Age > 18 years
  • Written informed consent given
  • Using adequate contraception [male and female participants]. Must take contraceptive measures during, and for at least six months after treatment.

Exclusion Criteria:

  • Distant metastasis (i.e. AJCC TNM stage IVc disease)
  • AJCC TNM Stage T1-2N0 disease
  • Treated with primary radical surgery to the primary site (e.g. resection)
  • Concurrent use of CYP3A4 inducers or inhibitors. [A standard course of dexamethasone or aprepitant for the prevention of cisplatin-induced nausea and vomiting is permitted]
  • Serious cardiac illness or other medical conditions precluding the use of cisplatin or cetuximab [no history of clinically significant cardiac disease, serious arrhythmias, or significant conduction abnormalities; no uncontrolled seizure disorder; no active neurologic disease; no neuropathy greater than grade 1]
  • Patients who have p16+ tumours who also have N2b, N2c or N3 nodal disease and whose lifetime smoking history is also more than 10 pack years (i.e. have both risk factors).
  • Pregnant or lactating
  • Previous treatment for any other cancer with cytotoxics, radiotherapy or anti-EGFR therapies
  • Inadequate renal, haematological or liver functions [Absolute neutrophil count <1,500/mm3; platelet count <100,000/mm3; WBC <3,000/mm3; haemoglobin <9 g/dL. [Haemoglobin correction by transfusion permitted.] Bilirubin > 1.5 times upper limit of normal (ULN); alkaline phosphatase > 2.5 times ULN; AST and ALT > 2.5 times ULN. Creatinine > 1.5 mg/dL; Creatinine clearance < 60 mL/min]
  • Patients with clinically significant hearing impairment
  • Life expectancy less than 3 months
  • Other malignancy within the past 3 years except basal cell skin cancer or pre-invasive carcinoma of the cervix.

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 identifier (NCT number): NCT01874171

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St Luke's Hospital
Dublin, Ireland, 6
Beaumont Hospital
Dublin, Ireland
VU University Medical Center
Amsterdam, Netherlands
United Kingdom
Aberdeen Royal Infirmary
Aberdeen, United Kingdom
Royal United Hospital
Bath, United Kingdom, BA1 3NG
Clatterbridge Cancer Centre
Bebington, United Kingdom, CH63 4JY
Bradford Royal Infirmary
Bradford, United Kingdom
Bristol Haematology & Oncology Centre
Bristol, United Kingdom, BS2 8ED
Velindre Hospital
Cardiff, United Kingdom, CF14 2TL
Cheltenham General Hospital
Cheltenham, United Kingdom, GL53 7AN
Colchester General Hospital
Colchester, United Kingdom
Castle Hill Hospital
Cottingham, United Kingdom
University Hospitals Coventry & Warwickshire
Coventry, United Kingdom, CV2 2DX
Royal Derby Hospital
Derby, United Kingdom
Queen Elizabeth Hospital Birmingham
Edgbaston, United Kingdom, B15 2TH
Western General Hospital
Edinburgh, United Kingdom, EH4 2XU
Royal Devon & Exeter Hospital
Exeter, United Kingdom, EX2 5DW
Royal Surrey County Hospital
Guildford, United Kingdom, GU2 7XX
St James's Institute of Oncology
Leeds, United Kingdom, LS9 7TF
Leicester Royal Infirmary
Leicester, United Kingdom, LE1 5WW
University College Hospital
London, United Kingdom, NW1 2PG
Royal Marsden Hospital
London, United Kingdom, SW3 6JJ
James Cook University Hospital
Middlesbrough, United Kingdom, TS4 3BW
New Cross Hospital
New Cross, United Kingdom
Northampton General Hospital
Northampton, United Kingdom
Norfolk & Norwich University Hospital
Norwich, United Kingdom
Nottingham University Hopsital
Nottingham, United Kingdom, NG5 1PB
Glan Clwyd Hospital
Rhyl, United Kingdom
Weston Park Hospital
Sheffield, United Kingdom, S10 2SJ
Royal Shrewsbury Hospital
Shrewsbury, United Kingdom
Royal Marsden Hospital
Sutton, United Kingdom
Singleton Hospital
Swansea, United Kingdom, SA2 8QA
Musgrove Park Hospital
Taunton, United Kingdom
Sponsors and Collaborators
University of Warwick
Cancer Research UK
University of Birmingham
University of Oxford
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Study Chair: Hisham Mehanna, PhD, BMedSc (hons), FRCS University of Birmingham

Additional Information:
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Responsible Party: Prof. Janet Dunn, Professor of Clinical Trials, University of Warwick Identifier: NCT01874171     History of Changes
Other Study ID Numbers: RMRCT0034
2011-005165-21 ( EudraCT Number )
ISRCTN33522080 ( Other Identifier: ISRCTN )
First Posted: June 10, 2013    Key Record Dates
Last Update Posted: May 8, 2017
Last Verified: May 2017

Additional relevant MeSH terms:
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Carcinoma, Squamous Cell
Neoplasms, Glandular and Epithelial
Neoplasms by Histologic Type
Neoplasms, Squamous Cell
Antineoplastic Agents
Antineoplastic Agents, Immunological