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

NCT ID: NCT00117572

Last Updated: 2018-04-09

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE3
• Total Enrollment: 285 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2004-11-30
• Study Completion Date: 2016-12-31

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.

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).

Conditions

Cancer of the Pharynx; Cancer of the Larynx; Cancer of the Nasal Cavity; Paranasal Sinus Neoplasms; Cancer of the Oral Cavity

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

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.

Group Type: ACTIVE_COMPARATOR

docetaxel

Intervention Type: DRUG

75 mg/m2 on day 1 (induction phase); 25 mg/m2 on day 1 (chemoradiotherapy phase)

cisplatin

Intervention Type: DRUG

75 mg/m2 on day 1

hydroxyurea

Intervention Type: DRUG

Each cycle: 500 mg PO q 12 hours x 6 days (11 doses)

fluorouracil

Intervention Type: DRUG

750 mg/m2/day on days 1-5 (induction phase); 600 mg/m2/day, day 0-4 (chemoradiotherapy phase)

chemotherapy

Intervention Type: PROCEDURE

See protocol for details

radiotherapy

Intervention Type: PROCEDURE

See protocol for details

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.

Group Type: ACTIVE_COMPARATOR

docetaxel

Intervention Type: DRUG

75 mg/m2 on day 1 (induction phase); 25 mg/m2 on day 1 (chemoradiotherapy phase)

hydroxyurea

Intervention Type: DRUG

Each cycle: 500 mg PO q 12 hours x 6 days (11 doses)

fluorouracil

Intervention Type: DRUG

750 mg/m2/day on days 1-5 (induction phase); 600 mg/m2/day, day 0-4 (chemoradiotherapy phase)

chemotherapy

Intervention Type: PROCEDURE

See protocol for details

radiotherapy

Intervention Type: PROCEDURE

See protocol for details

Interventions

docetaxel

75 mg/m2 on day 1 (induction phase); 25 mg/m2 on day 1 (chemoradiotherapy phase)

Intervention Type: DRUG

cisplatin

75 mg/m2 on day 1

Intervention Type: DRUG

hydroxyurea

Each cycle: 500 mg PO q 12 hours x 6 days (11 doses)

Intervention Type: DRUG

fluorouracil

750 mg/m2/day on days 1-5 (induction phase); 600 mg/m2/day, day 0-4 (chemoradiotherapy phase)

Intervention Type: DRUG

chemotherapy

See protocol for details

Intervention Type: PROCEDURE

radiotherapy

See protocol for details

Intervention Type: PROCEDURE

Eligibility 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.

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

Sponsors

University of Chicago

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Everett Vokes, M.D.

Role: PRINCIPAL_INVESTIGATOR

University of Chicago

Locations

USC University of Southern California Keck School of Medicine

Los Angeles, California, United States

UM Sylvester Comprehensive Cancer Center

Miami, Florida, United States

Northwestern University

Chicago, Illinois, United States

Rush University Medical Center

Chicago, Illinois, United States

The University of Chicago

Chicago, Illinois, United States

Weiss Memorial Hospital

Chicago, Illinois, United States

Evanston Northwestern Healthcare

Evanston, Illinois, United States

Joliet Oncology Hematology Associates

Joliet, Illinois, United States

Fort Wayne Medical Oncology/Hematology Inc.

Fort Wayne, Indiana, United States

AP&S Clinic, LLC

Terre Haute, Indiana, United States

University of Kansas Cancer Center

Kansas City, Kansas, United States

Henry Ford Health System

Detroit, Michigan, United States

Oncology Care Associates PLLC

Saint Joseph, Michigan, United States

University of Minnesota

Minneapolis, Minnesota, United States

Kansas City VA Medical Center

Kansas City, Missouri, United States

Roger Maris Cancer Center

Fargo, North Dakota, United States

Fox Chase Cancer Center

Philadelphia, Pennsylvania, United States

University of Tennessee Cancer Institute

Memphis, Tennessee, United States

UT Health Science Center at San Antonio

San Antonio, Texas, United States

Oncology Alliance

Milwaukee, Wisconsin, United States

Clinic of Oncology, University Hospital Center Zagreb

Zagreb, , Croatia

University Hospital for Tumors Zagreb

Zagreb, , Croatia

Clinique Armoricaine de Radiologie

Saint-Brieuc, , France

NN Blokhin Russian Cancer Research Centre RAMS

Moscow, , Russia

Republican Oncology Dispensary

Ufa, , Russia

Hospital Clínico San Carlos

Madrid, , Spain

Countries

United States; Croatia; France; Russia; Spain

Other Identifiers

13362B

Identifier Type: -

Identifier Source: org_study_id