Carboplatin, Capecitabine, and Radiation Therapy in Treating Patients With Stage III or Stage IV Head and Neck Cancer

NCT ID: NCT00114153

Last Updated: 2009-11-26

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE1
• Total Enrollment: 48 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2003-06-30

Brief Summary

RATIONALE: Drugs used in chemotherapy, such as carboplatin and capecitabine, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Radiation therapy uses high-energy x-rays to kill tumor cells. Giving chemotherapy together with radiation therapy may kill more tumor cells.

PURPOSE: This phase I trial is studying the side effects and best dose of capecitabine when given together with carboplatin followed by radiation therapy in treating patients with stage III or stage IV head and neck cancer.

Detailed Description

OBJECTIVES:

Primary

• Determine the maximum tolerated dose (MTD) of capecitabine when administered with carboplatin as induction chemotherapy in patients with stage III-IVB squamous cell carcinoma of the head and neck.
• Determine the MTD of capecitabine when administered with concurrent carboplatin and intensity-modulated radiotherapy in these patients.
• Determine the toxicity of this regimen in these patients.

Secondary

• Determine, preliminarily, tumor response in patients treated with this regimen.
• Determine the quality of life of patients treated with this regimen.

OUTLINE: This is a dose-escalation study of capecitabine.

• Induction chemotherapy: Patients receive carboplatin IV on days 1, 8, 15, 22, 29, and 36 and oral capecitabine twice daily on days 1-14 and 22-35.
• Concurrent chemoradiotherapy: Beginning 2 weeks after completion of induction chemotherapy, patients receive carboplatin and capecitabine as in induction chemotherapy. Patients also undergo intensity-modulated radiotherapy (IMRT) once daily on days 1-5, 8-12, 15-19, 22-26, and 29-33 and non-IMRT boost once daily on days 36-40 and 43-47.

Treatment continues in the absence of disease progression or unacceptable toxicity.

Within 4-8 weeks after completion of concurrent chemoradiotherapy, patients who achieve a clinical complete response or who are medically operable with resectable persistent or recurrent disease undergo neck dissection (salvage surgery).

Cohorts of 3-6 patients receive escalating doses of capecitabine (during both induction chemotherapy and concurrent chemoradiotherapy) until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity.

Quality of life is assessed at baseline, after completion of induction chemotherapy, and then at 1 week and 3, 6, and 12 months after completion of concurrent chemoradiotherapy.

After completion of study therapy, patients are followed monthly for 3 months and then every 3 months for 1 year.

PROJECTED ACCRUAL: Approximately 6-48 patients will be accrued for this study.

Conditions

Head and Neck Cancer

Keywords

stage III squamous cell carcinoma of the hypopharynx; stage III squamous cell carcinoma of the lip and oral cavity; stage III squamous cell carcinoma of the oropharynx; stage IV squamous cell carcinoma of the hypopharynx; stage IV squamous cell carcinoma of the lip and oral cavity; stage IV squamous cell carcinoma of the oropharynx

Study Design

• Primary Study Purpose: TREATMENT

Interventions

capecitabine

Intervention Type: DRUG

carboplatin

Intervention Type: DRUG

conventional surgery

Intervention Type: PROCEDURE

radiation therapy

Intervention Type: RADIATION

Eligibility Criteria

Inclusion Criteria

DISEASE CHARACTERISTICS:

• Histologically confirmed squamous cell carcinoma of the head and neck, including 1 of the following types:

• Oral cavity
• Oropharynx
• Hypopharynx
• Clinical stage III-IVB (T2-T4, N0-N3, M0) disease
• Measurable disease by physical exam, endoscopy, and/or CT scan or MRI

• Residual measurable disease after fine needle aspiration, core needle biopsy, or incisional or excisional biopsy of the primary tumor
• No evidence of distant metastases (M1)

PATIENT CHARACTERISTICS:

Age

• 18 and over

Performance status

• Zubrod 0-1

Life expectancy

• Not specified

Hematopoietic

• Absolute neutrophil count > 1,500/mm^3
• Platelet count > 100,000/mm^3
• Hemoglobin > 9 g/dL
• No uncontrolled coagulopathy

Hepatic

• AST < 2 times normal
• Alkaline phosphatase < 2 times normal
• Bilirubin normal

Renal

• Creatinine < 2.0 mg/dL OR
• Creatinine clearance > 50 mL/min

Cardiovascular

• No congestive heart failure
• No symptomatic coronary artery disease
• No uncontrolled cardiac arrhythmias
• No myocardial infarction within the past year
• No other clinically significant cardiac disease

Other

• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception during and for at least 30 days after completion of study treatment
• Nutritional and general physical condition must be compatible with proposed study treatment
• Mentally reliable
• No pre-existing peripheral neuropathy > grade 1
• No history of hypersensitivity to fluorouracil, capecitabine, or carboplatin
• No active infection
• No other malignancy within the past 5 years except nonmelanoma skin cancer
• No major medical, psychiatric, or neurologic illness that would preclude study participation or giving informed consent

PRIOR CONCURRENT THERAPY:

Biologic therapy

• Not specified

Chemotherapy

• More than 5 years since prior chemotherapy

Endocrine therapy

• Not specified

Radiotherapy

• No prior radiotherapy for head and neck tumor
• No prior radiotherapy to the region of planned study radiotherapy fields

Surgery

• Recovered from prior surgery

• No unhealed surgical wounds

Other

• More than 4 weeks since prior investigational drugs
• No concurrent warfarin, diphenylhydantoin, or fluconazole unless willing to undergo careful monitoring and appropriate dose adjustments

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

National Cancer Institute (NCI)

NIH

Sponsor Role: collaborator

University of Virginia

OTHER

Sponsor Role: lead

Principal Investigators

Christopher Y. Thomas, MD

Role: PRINCIPAL_INVESTIGATOR

University of Virginia

Paul W. Read, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

University of Virginia

Locations

University of Virginia Cancer Center at UV Health System

Charlottesville, Virginia, United States

Countries

United States

References

Thomas CY, Read P, Petroni G, Reibel J, Levine PA. Phase I study of capecitabine, carboplatin and intensity-modulated radiation therapy for head and neck cancer. Anticancer Res. 2009 Jul;29(7):2869-73.

Reference Type: RESULT

PMID: 19596976 (View on PubMed)

Other Identifiers

UVACC-HIC-10519

Identifier Type: -

Identifier Source: secondary_id

UVACC-27402

Identifier Type: -

Identifier Source: secondary_id

BMS-UVACC-HIC-10519

Identifier Type: -

Identifier Source: secondary_id

CDR0000432949

Identifier Type: -

Identifier Source: org_study_id