Combination Chemotherapy and Radiation Therapy in Treating Patients With Locally Advanced Head and Neck Cancer

NCT ID: NCT00352118

Last Updated: 2017-12-28

Study Results

Results available

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Basic Information

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Recruitment Status

TERMINATED

Clinical Phase

PHASE2

Total Enrollment

4 participants

Study Classification

INTERVENTIONAL

Study Start Date

2006-03-31

Study Completion Date

2008-04-30

Brief Summary

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RATIONALE: Drugs used in chemotherapy, such as docetaxel, cisplatin, and fluorouracil, 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 combination chemotherapy together with radiation therapy may kill more tumor cells.

PURPOSE: This phase II trial is studying how well giving combination chemotherapy together with radiation therapy works in treating patients with locally advanced head and neck cancer. The doctor also wants to find out if patients who receive this treatment need a feeding tube 1 year after starting treatment.

Detailed Description

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OBJECTIVES:

Primary

* Determine feeding tube dependency at 12 months in patients with locally advanced head and neck cancer treated with induction chemotherapy comprising docetaxel, cisplatin, and fluorouracil followed by cisplatin and reduced-dose radiotherapy.

Secondary

* Determine the progression-free, disease-free, and overall survival of patients treated with this regimen.
* Determine the pattern of failure in patients treated with this regimen.
* Evaluate the quality of life of patients treated with this regimen.
* Assess pre- and post-treatment swallowing ability of patients and the impact on their quality of life.

Tertiary

* Quantify salivary flow rates of patients receiving chemotherapy with radiotherapy for head and neck malignancy.
* Evaluate the quality of saliva by examining total protein concentrations.
* Quantify proangiogenic cytokines (interleukin \[IL\]-1, IL-6, IL-8, and vascular endothelial growth factor) in the saliva of these patients.
* Determine the degree of mucositis and xerostomia of patients receiving chemotherapy with radiotherapy for head and neck malignancy.
* Compare salivary flow rates with the grade of mucositis and xerostomia of patients receiving chemotherapy with radiotherapy for head and neck malignancy.

OUTLINE: This is a pilot study.

* Induction therapy: Patients receive docetaxel IV over 1 hour and cisplatin IV over 1 hour on day 1 followed by fluorouracil IV continuously on days 1- 4. Patients also receive filgrastim (G-CSF) subcutaneously (SC) on days 5-14 or pegfilgrastim SC on day 5. Treatment repeats every 3 weeks for 2 courses in the absence of disease progression or unacceptable toxicity. Patients achieving a partial or clinical complete response proceed to chemoradiotherapy 3 weeks later.
* Chemoradiotherapy: Patients receive cisplatin IV over 1 hour on day 1. Treatment repeats every 3 weeks for 3 courses in the absence of disease progression or unacceptable toxicity. Patients also undergo concurrent reduced-dose radiotherapy 5 days a week for 6 weeks.
* Surgery: Approximately 6 to 8 weeks after completing chemoradiotherapy, patients with residual neck disease or disease initially staged at N2 or greater undergo neck dissection.

Saliva is collected periodically to measure flow rates and quality; quantify proangiogenic cytokines (interleukin \[IL\]-1, IL-6, IL-8 and vascular endothelial growth factor); and examine the grade of mucositis and xerostomia.

Quality of life is assessed at baseline, before chemoradiotherapy, 1 month after the last radiation treatment, every 3 months for 1 year, and then every 6 months for 1 year.

After completion of study treatment, patients are followed periodically for 5 years and then annually thereafter.

PROJECTED ACCRUAL: A total of 36 patients will be accrued for this study.

Conditions

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Head and Neck Cancer

Keywords

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oral complications of radiation therapy oral complications of chemotherapy mucositis xerostomia stage III squamous cell carcinoma of the hypopharynx stage IV squamous cell carcinoma of the hypopharynx stage III squamous cell carcinoma of the larynx stage IV squamous cell carcinoma of the larynx stage III squamous cell carcinoma of the lip and oral cavity stage IV squamous cell carcinoma of the lip and oral cavity stage III squamous cell carcinoma of the oropharynx stage IV squamous cell carcinoma of the oropharynx

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Chemotherapy + Low Dose Radiation

Patients receiving chemotherapy and Low Dose (60 Gy) Radiation per protocol.

Group Type EXPERIMENTAL

filgrastim

Intervention Type BIOLOGICAL

subcutaneously on Days 5-14, repeating every 3 weeks for 2 courses.

pegfilgrastim

Intervention Type BIOLOGICAL

If applicable on day 5, repeating every 3 weeks for 2 courses.

cisplatin

Intervention Type DRUG

Intravenous over 1 hour on day 1, every 3 weeks for 3 courses.

docetaxel

Intervention Type DRUG

Intravenous over 1 hour on day 1.

fluorouracil

Intervention Type DRUG

Intravenous continuously on days 1-4.

conventional surgery

Intervention Type PROCEDURE

As appropriate, neck dissection.

radiation therapy

Intervention Type RADIATION

60 Gy 5 days/week x 6 weeks with cisplatin

Interventions

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filgrastim

subcutaneously on Days 5-14, repeating every 3 weeks for 2 courses.

Intervention Type BIOLOGICAL

pegfilgrastim

If applicable on day 5, repeating every 3 weeks for 2 courses.

Intervention Type BIOLOGICAL

cisplatin

Intravenous over 1 hour on day 1, every 3 weeks for 3 courses.

Intervention Type DRUG

docetaxel

Intravenous over 1 hour on day 1.

Intervention Type DRUG

fluorouracil

Intravenous continuously on days 1-4.

Intervention Type DRUG

conventional surgery

As appropriate, neck dissection.

Intervention Type PROCEDURE

radiation therapy

60 Gy 5 days/week x 6 weeks with cisplatin

Intervention Type RADIATION

Other Intervention Names

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G-CSF Neupogen Neulasta, G-CSF CDDP cisplatinum cis-diamminedichloridoplatinum Platinol AQ Taxotere(R) 5-FU 5-fluorouracil Adrucil surgery radiation

Eligibility Criteria

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Inclusion Criteria

* Histologically confirmed squamous cell carcinoma of the head and neck

* Stage IVA or IVB disease

* Stage III disease allowed provided patient may benefit from organ preservation or patient refused surgery
* Measurable or evaluable disease
* ECOG performance status 0-2
* Absolute neutrophil count ≥ 1,500/mm\^3
* Platelet count ≥ 100,000/mm\^3
* Creatinine ≤ 1.5 mg/dL OR glomerular filtration rate ≥ 60 mL/min
* Bilirubin normal
* Alkaline phosphatase (AP) and AST or ALT must be within the following ranges:

* AP normal AND AST or ALT ≤ 5 times upper limit of normal (ULN)
* AP ≤ 2.5 times ULN AND AST or ALT ≤ 1.5 times ULN
* AP ≤ 5 times ULN AND AST or ALT normal

Exclusion Criteria

* Salivary gland, sinus, or nasopharyngeal primary disease
* Evidence of distant metastatic disease
* Pregnant or nursing
* Positive pregnancy test (Fertile patients must use effective contraception during study treatment and for 3 months after completion of study treatment)
* Other malignancy within the past 5 years except for adequately treated basal cell or squamous cell skin cancer, in situ cervical cancer, or other malignancy in which stage and nature of disease is such that it is unlikely to affect survival for the next 3 years
* Peripheral neuropathy ≥ grade 2
* Hearing loss ≥ grade 2
* Severe hypersensitivity reaction to docetaxel or other drugs formulated with polysorbate 80 and/or cisplatin or other platinum analogs
* Poor nutritional status, in the opinion of the investigator
* Active infection
* Active ischemic heart disease
* Myocardial infarction within the past 6 months
* Prior radiotherapy above the clavicles
* Prior chemotherapy
* Prior surgery to the primary tumor except biopsy
* Concurrent amifostine or other investigational agents
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Cancer Institute (NCI)

NIH

Sponsor Role collaborator

Masonic Cancer Center, University of Minnesota

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Frank G. Ondrey, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Masonic Cancer Center, University of Minnesota

Locations

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Masonic Cancer Center at University of Minnesota

Minneapolis, Minnesota, United States

Site Status

Countries

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United States

Other Identifiers

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UMN-0502M67486

Identifier Type: -

Identifier Source: secondary_id

2005LS012

Identifier Type: -

Identifier Source: org_study_id