Bevacizumab, Cisplatin, Radiation Therapy, and Fluorouracil in Treating Patients With Stage IIB, Stage III, Stage IVA, or Stage IVB Nasopharyngeal Cancer

NCT ID: NCT00408694

Last Updated: 2018-01-30

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE2

Total Enrollment

46 participants

Study Classification

INTERVENTIONAL

Study Start Date

2006-12-13

Study Completion Date

2011-12-15

Brief Summary

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This phase II trial is studying how well giving bevacizumab together with cisplatin, radiation therapy, and fluorouracil works in treating patients with stage IIB, stage III, stage IVA, or stage IVB nasopharyngeal cancer. Monoclonal antibodies, such as bevacizumab, can block tumor growth in different ways. Some block the ability of tumor cells to grow and spread. Others find tumor cells and help kill them or carry tumor-killing substances to them. Bevacizumab may also stop the growth of nasopharyngeal cancer by blocking blood flow to the tumor. Drugs used in chemotherapy, such as 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 bevacizumab together with chemotherapy and radiation therapy may kill more tumor cells.

Detailed Description

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PRIMARY OBJECTIVES:

I. Determine the safety and tolerability of bevacizumab and chemoradiotherapy comprising cisplatin and radiotherapy followed by adjuvant therapy comprising cisplatin, fluorouracil, and bevacizumab in patients with stage IIB-IVB nasopharyngeal cancer.

SECONDARY OBJECTIVES:

I. Determine the 1- and 2-year rates of locoregional progression-free in patients treated with this regimen.

II. Determine the 1- and 2-year rates of distant metastases-free in patients treated with this regimen.

III. Determine the 1- and 2-year rates of progression-free and overall survival of patients treated with this regimen.

OUTLINE: This is a multicenter study.

BEVACIZUMAB AND CHEMORADIOTHERAPY: Patients receive bevacizumab IV over 30-90 minutes and cisplatin IV over 20-30 minutes on day 1. Treatment repeats every 21 days for 3 courses in the absence of disease progression or unacceptable toxicity. Beginning in week 1, patients also undergo three-dimensional conformal radiotherapy or intensity-modulated radiotherapy once daily 5 days a week for a total of 33 fractions.

ADJUVANT THERAPY: Beginning in week 10, patients receive fluorouracil IV continuously over 96 hours on days 1-4, cisplatin IV over 20-30 minutes on day 1 OR days 1 and 2, and bevacizumab IV over 30-90 minutes on day 1. Treatment repeats every 21 days for 3 courses in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed periodically.

Conditions

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Stage II Nasopharyngeal Keratinizing Squamous Cell Carcinoma AJCC v7 Stage III Nasopharyngeal Keratinizing Squamous Cell Carcinoma AJCC v7 Stage III Nasopharyngeal Undifferentiated Carcinoma AJCC v7 Stage IV Nasopharyngeal Keratinizing Squamous Cell Carcinoma AJCC v7 Stage IV Nasopharyngeal Undifferentiated Carcinoma AJCC v7

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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Treatment (bevacizumab, cisplatin, fluorouracil, IMRT, 3D-CRT)

BEVACIZUMAB AND CHEMORADIOTHERAPY: Patients receive bevacizumab IV over 30-90 minutes and cisplatin IV over 20-30 minutes on day 1. Treatment repeats every 21 days for 3 courses in the absence of disease progression or unacceptable toxicity. Beginning in week 1, patients also undergo three-dimensional conformal radiotherapy or intensity-modulated radiotherapy once daily 5 days a week for a total of 33 fractions.

ADJUVANT THERAPY: Beginning in week 10, patients receive fluorouracil IV continuously over 96 hours on days 1-4, cisplatin IV over 20-30 minutes on day 1 OR days 1 and 2, and bevacizumab IV over 30-90 minutes on day 1. Treatment repeats every 21 days for 3 courses in the absence of disease progression or unacceptable toxicity.

Group Type EXPERIMENTAL

3-Dimensional Conformal Radiation Therapy

Intervention Type RADIATION

Undergo 3D-CRT

Bevacizumab

Intervention Type BIOLOGICAL

Given IV

Cisplatin

Intervention Type DRUG

Given IV

Fluorouracil

Intervention Type DRUG

Given IV

Intensity-Modulated Radiation Therapy

Intervention Type RADIATION

Undergo IMRT

Interventions

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3-Dimensional Conformal Radiation Therapy

Undergo 3D-CRT

Intervention Type RADIATION

Bevacizumab

Given IV

Intervention Type BIOLOGICAL

Cisplatin

Given IV

Intervention Type DRUG

Fluorouracil

Given IV

Intervention Type DRUG

Intensity-Modulated Radiation Therapy

Undergo IMRT

Intervention Type RADIATION

Other Intervention Names

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3-dimensional radiation therapy 3D CONFORMAL RADIATION THERAPY 3D CRT 3D-CRT Conformal Therapy Radiation Conformal Therapy Anti-VEGF Anti-VEGF Humanized Monoclonal Antibody Anti-VEGF rhuMAb Avastin Bevacizumab Biosimilar BEVZ92 Bevacizumab Biosimilar BI 695502 Bevacizumab Biosimilar CBT 124 Bevacizumab Biosimilar FKB238 BEVACIZUMAB, LICENSE HOLDER UNSPECIFIED Immunoglobulin G1 (Human-Mouse Monoclonal rhuMab-VEGF Gamma-Chain Anti-Human Vascular Endothelial Growth Factor), Disulfide With Human-Mouse Monoclonal rhuMab-VEGF Light Chain, Dimer Recombinant Humanized Anti-VEGF Monoclonal Antibody rhuMab-VEGF Abiplatin Blastolem Briplatin CDDP Cis-diammine-dichloroplatinum Cis-diamminedichloridoplatinum Cis-diamminedichloro Platinum (II) Cis-diamminedichloroplatinum Cis-dichloroammine Platinum (II) Cis-platinous Diamine Dichloride Cis-platinum Cis-platinum II Cis-platinum II Diamine Dichloride Cismaplat Cisplatina Cisplatinum Cisplatyl Citoplatino Citosin Cysplatyna DDP Lederplatin Metaplatin Neoplatin Peyrone's Chloride Peyrone's Salt Placis Plastistil Platamine Platiblastin Platiblastin-S Platinex Platinol Platinol- AQ Platinol-AQ Platinol-AQ VHA Plus Platinoxan Platinum Platinum Diamminodichloride Platiran Platistin Platosin 5-Fluoro-2,4(1H, 3H)-pyrimidinedione 5-Fluorouracil 5-Fluracil 5-FU AccuSite Carac Fluoro Uracil Fluouracil Flurablastin Fluracedyl Fluracil Fluril Fluroblastin Ribofluor Ro 2-9757 Ro-2-9757 IMRT Intensity Modulated RT Intensity-Modulated Radiotherapy

Eligibility Criteria

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Inclusion Criteria

* Histologically confirmed cancer of the nasopharynx based on biopsy of a primary lesion and/or lymph nodes

* Histologic WHO types I-IIb/III
* Stage IIB-IVB disease

* No T1-2, N1 disease in which node positivity is based on the presence of retropharyngeal lymph nodes
* No distant metastases
* Zubrod performance status 0-1
* WBC ? 4,000/mm?
* Hemoglobin ? 9.0 g/dL
* Platelet count ? 100,000/mm?
* Absolute neutrophil count ? 1,500/mm?
* INR ? 1.5
* aPTT ? 1.5 times upper limit of normal (ULN)
* Alkaline phosphatase ? 1.5 times ULN
* ALT and AST ? 1.5 times ULN
* Bilirubin ? 1.5 times ULN
* Creatinine ? 1.5 mg/dL OR creatinine clearance ? 55 mL/min
* Urine protein:creatinine (UPC) ratio \< 1.0

* If UPC \> 0.5, 24-hour urine protein must be \< 1,000 mg
* Hearing loss primarily sensorineural in nature and requiring a hearing aid or intervention that interferes in a clinically significant way with activities of daily living allowed
* Conductive hearing loss from tumor-related otitis media is allowed
* No severe, active comorbidity, including any of the following:

* Ongoing bleeding diathesis, hemorrhagic disorder, or coagulopathy within the past 6 months
* Abdominal fistula, gastrointestinal perforation, or intra-abdominal abscess within the past 6 months
* Esophageal varices, nonhealing wound, nonhealing ulcer, or bone fracture within the past 6 months
* Chronic obstructive pulmonary disease exacerbation or other respiratory illness requiring hospitalization or precluding study therapy within the past 30 days
* Unstable angina and/or congestive heart failure or peripheral vascular disease requiring hospitalization within the past 12 months
* Major medical or psychiatric illness that, in the opinion of the study investigator, would preclude study compliance
* Active, untreated infection and/or acute bacterial or fungal infection requiring intravenous antibiotics
* Hepatic insufficiency resulting in clinical jaundice and/or coagulation defects
* History of significant weight loss (\> 15% from baseline)
* History of arterial thromboembolic events
* Acquired immune deficiency syndrome
* Transmural myocardial infarction
* Cerebrovascular accident
* Transient ischemic attack
* Any other cardiac condition that, in the opinion of the investigator, would preclude study compliance
* No gross hemoptysis or hematemesis, defined as bright red blood of ? 1 teaspoon per coughing episode, within the last 4 weeks (incidental blood mixed with phlegm allowed)
* No other invasive malignancy within the past 3 years except nonmelanoma skin cancer or carcinoma in situ of the breast, oral cavity, or cervix
* Nutritional and physical condition considered suitable for study treatment
* No significant traumatic injury within the past 4 weeks
* No history of allergic reaction to the study drugs
* No baseline blood pressure \> 150/100 mm Hg
* No peripheral neuropathy ? grade 2
* Not pregnant or nursing
* Negative serum pregnancy test
* Fertile patients must use effective contraception during and for ? 6 months after completion of study treatment
* At least 10 days since prior and no concurrent dipyridamole, ticlopidine, clopidogrel bisulfate, cilostazol, warfarin, heparin, daily treatment with acetylsalicylic acid (\> 325 mg/day), or nonsteroidal anti-inflammatory medications known to inhibit platelet function
* No prior head and neck surgery of the primary tumor or lymph nodes except for incisional or excisional biopsies

* More than 15 days since prior biopsies
* More than 1 week since prior fine-needle aspirations or placement of percutaneous gastrostomy tube
* More than 4 weeks since prior major surgical procedures
* No prior radiotherapy to the region of the study cancer that would result in overlap of radiation therapy fields
* No prior bevacizumab or other vascular endothelial growth factor-targeting agents
* No prior systemic chemotherapy for the study cancer

* Prior chemotherapy for a different cancer allowed
* No concurrent hematologic growth factors (e.g. filgrastim \[G-CSF\], darbepoetin alfa, epoetin alfa) during study chemoradiotherapy
* No concurrent prophylactic growth factors for neutropenia during study adjuvant therapy
* No concurrent prophylactic amifostine or pilocarpine
* No other concurrent experimental therapeutic cancer treatments
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Radiation Therapy Oncology Group

NETWORK

Sponsor Role collaborator

National Cancer Institute (NCI)

NIH

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Nancy Lee

Role: PRINCIPAL_INVESTIGATOR

Radiation Therapy Oncology Group

Locations

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University of Alabama at Birmingham Cancer Center

Birmingham, Alabama, United States

Site Status

Sutter Cancer Centers Radiation Oncology Services-Auburn

Auburn, California, United States

Site Status

Providence Saint Joseph Medical Center/Disney Family Cancer Center

Burbank, California, United States

Site Status

Sutter Cancer Centers Radiation Oncology Services-Cameron Park

Cameron Park, California, United States

Site Status

Mercy San Juan Medical Center

Carmichael, California, United States

Site Status

East Bay Radiation Oncology Center

Castro Valley, California, United States

Site Status

Eden Hospital Medical Center

Castro Valley, California, United States

Site Status

Valley Medical Oncology Consultants-Castro Valley

Castro Valley, California, United States

Site Status

City of Hope Comprehensive Cancer Center

Duarte, California, United States

Site Status

Bay Area Breast Surgeons Inc

Emeryville, California, United States

Site Status

Valley Medical Oncology Consultants-Fremont

Fremont, California, United States

Site Status

Contra Costa Regional Medical Center

Martinez, California, United States

Site Status

Highland General Hospital

Oakland, California, United States

Site Status

Alta Bates Summit Medical Center - Summit Campus

Oakland, California, United States

Site Status

Bay Area Tumor Institute

Oakland, California, United States

Site Status

Hematology and Oncology Associates-Oakland

Oakland, California, United States

Site Status

Tom K Lee Inc

Oakland, California, United States

Site Status

Stanford Cancer Institute Palo Alto

Palo Alto, California, United States

Site Status

Valley Care Health System - Pleasanton

Pleasanton, California, United States

Site Status

Valley Medical Oncology Consultants

Pleasanton, California, United States

Site Status

Sutter Cancer Centers Radiation Oncology Services-Roseville

Roseville, California, United States

Site Status

Sutter Medical Center Sacramento

Sacramento, California, United States

Site Status

Mercy General Hospital Radiation Oncology Center

Sacramento, California, United States

Site Status

Doctors Medical Center- JC Robinson Regional Cancer Center

San Pablo, California, United States

Site Status

Sutter Cancer Centers Radiation Oncology Services-Vacaville

Vacaville, California, United States

Site Status

Beebe Medical Center

Lewes, Delaware, United States

Site Status

Christiana Care Health System-Christiana Hospital

Newark, Delaware, United States

Site Status

Boca Raton Regional Hospital

Boca Raton, Florida, United States

Site Status

Baptist MD Anderson Cancer Center

Jacksonville, Florida, United States

Site Status

Integrated Community Oncology Network-Southside Cancer Center

Jacksonville, Florida, United States

Site Status

Baptist Medical Center South

Jacksonville, Florida, United States

Site Status

Integrated Community Oncology Network-Florida Cancer Center Beaches

Jacksonville Beach, Florida, United States

Site Status

Baptist Hospital of Miami

Miami, Florida, United States

Site Status

21st Century Oncology-Orange Park

Orange Park, Florida, United States

Site Status

UF Cancer Center at Orlando Health

Orlando, Florida, United States

Site Status

21st Century Oncology-Palatka

Palatka, Florida, United States

Site Status

Integrated Community Oncology Network-Flager Cancer Center

Saint Augustine, Florida, United States

Site Status

Memorial University Medical Center

Savannah, Georgia, United States

Site Status

John H Stroger Jr Hospital of Cook County

Chicago, Illinois, United States

Site Status

Saint Vincent Anderson Regional Hospital/Cancer Center

Anderson, Indiana, United States

Site Status

Union Hospital of Cecil County

Elkton, Maryland, United States

Site Status

Bronson Battle Creek

Battle Creek, Michigan, United States

Site Status

Spectrum Health Big Rapids Hospital

Big Rapids, Michigan, United States

Site Status

Cancer Research Consortium of West Michigan NCORP

Grand Rapids, Michigan, United States

Site Status

Mercy Health Saint Mary's

Grand Rapids, Michigan, United States

Site Status

Spectrum Health at Butterworth Campus

Grand Rapids, Michigan, United States

Site Status

Holland Community Hospital

Holland, Michigan, United States

Site Status

Borgess Medical Center

Kalamazoo, Michigan, United States

Site Status

Bronson Methodist Hospital

Kalamazoo, Michigan, United States

Site Status

West Michigan Cancer Center

Kalamazoo, Michigan, United States

Site Status

Mercy Health Partners-Hackley Campus

Muskegon, Michigan, United States

Site Status

Munson Medical Center

Traverse City, Michigan, United States

Site Status

Metro Health Hospital

Wyoming, Michigan, United States

Site Status

Singing River Hospital

Pascagoula, Mississippi, United States

Site Status

Siteman Cancer Center at Saint Peters Hospital

City of Saint Peters, Missouri, United States

Site Status

Mercy Hospital Springfield

Springfield, Missouri, United States

Site Status

CoxHealth South Hospital

Springfield, Missouri, United States

Site Status

Saint Louis Children's Hospital

St Louis, Missouri, United States

Site Status

Washington University School of Medicine

St Louis, Missouri, United States

Site Status

University Medical Center of Southern Nevada

Las Vegas, Nevada, United States

Site Status

Cooper Hospital University Medical Center

Camden, New Jersey, United States

Site Status

Virtua Memorial

Mount Holly, New Jersey, United States

Site Status

Saint Peter's University Hospital

New Brunswick, New Jersey, United States

Site Status

Rutgers New Jersey Medical School

Newark, New Jersey, United States

Site Status

Community Medical Center

Toms River, New Jersey, United States

Site Status

Roswell Park Cancer Institute

Buffalo, New York, United States

Site Status

Beth Israel Medical Center

New York, New York, United States

Site Status

Saint Luke's Roosevelt Hospital Center - Saint Luke's Division

New York, New York, United States

Site Status

Rutherford Hospital

Rutherfordton, North Carolina, United States

Site Status

Summa Akron City Hospital/Cooper Cancer Center

Akron, Ohio, United States

Site Status

Cleveland Clinic Foundation

Cleveland, Ohio, United States

Site Status

University of Oklahoma Health Sciences Center

Oklahoma City, Oklahoma, United States

Site Status

UPMC-Heritage Valley Health System Beaver

Beaver, Pennsylvania, United States

Site Status

UPMC Cancer Center at Clarion Hospital

Clarion, Pennsylvania, United States

Site Status

Northeast Radiation Oncology Center

Dunmore, Pennsylvania, United States

Site Status

Pocono Medical Center

East Stroudsburg, Pennsylvania, United States

Site Status

UPMC Cancer Centers - Arnold Palmer Pavilion

Greensburg, Pennsylvania, United States

Site Status

UPMC-Johnstown/John P. Murtha Regional Cancer Center

Johnstown, Pennsylvania, United States

Site Status

UPMC Cancer Center at UPMC McKeesport

McKeesport, Pennsylvania, United States

Site Status

Upper Delaware Valley Cancer Center

Milford, Pennsylvania, United States

Site Status

UPMC-Coraopolis/Heritage Valley Radiation Oncology

Moon Township, Pennsylvania, United States

Site Status

UPMC Cancer Center-Natrona Heights

Natrona Heights, Pennsylvania, United States

Site Status

UPMC Jameson

New Castle, Pennsylvania, United States

Site Status

Radiation Therapy Oncology Group

Philadelphia, Pennsylvania, United States

Site Status

Thomas Jefferson University Hospital

Philadelphia, Pennsylvania, United States

Site Status

UPMC-Magee Womens Hospital

Pittsburgh, Pennsylvania, United States

Site Status

UPMC-Presbyterian Hospital

Pittsburgh, Pennsylvania, United States

Site Status

UPMC-Saint Margaret

Pittsburgh, Pennsylvania, United States

Site Status

UPMC-Shadyside Hospital

Pittsburgh, Pennsylvania, United States

Site Status

UPMC Jefferson Regional Radiation Oncology

Pittsburgh, Pennsylvania, United States

Site Status

UPMC-Passavant Hospital

Pittsburgh, Pennsylvania, United States

Site Status

UPMC-Saint Clair Hospital Cancer Center

Pittsburgh, Pennsylvania, United States

Site Status

UPMC Cancer Center at UPMC Northwest

Seneca, Pennsylvania, United States

Site Status

UPMC Uniontown Hospital Radiation Oncology

Uniontown, Pennsylvania, United States

Site Status

UPMC Washington Hospital Radiation Oncology

Washington, Pennsylvania, United States

Site Status

AnMed Health Hospital

Anderson, South Carolina, United States

Site Status

Medical University of South Carolina

Charleston, South Carolina, United States

Site Status

Spartanburg Medical Center

Spartanburg, South Carolina, United States

Site Status

Brooke Army Medical Center

Fort Sam Houston, Texas, United States

Site Status

M D Anderson Cancer Center

Houston, Texas, United States

Site Status

Wilford Hall Medical Center

Lackland Air Force Base, Texas, United States

Site Status

Wheeling Hospital/Schiffler Cancer Center

Wheeling, West Virginia, United States

Site Status

Froedtert and the Medical College of Wisconsin

Milwaukee, Wisconsin, United States

Site Status

Aspirus UW Cancer Center

Wisconsin Rapids, Wisconsin, United States

Site Status

Tom Baker Cancer Centre

Calgary, Alberta, Canada

Site Status

London Regional Cancer Program

London, Ontario, Canada

Site Status

University Health Network-Princess Margaret Hospital

Toronto, Ontario, Canada

Site Status

McGill University Department of Oncology

Montreal, Quebec, Canada

Site Status

Countries

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United States Canada

References

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Lee NY, Harris J, Kim J, Garden A, Mechalakos J, Pfister DG, Chan ATC, Hu K, Colevas AD, Frank S, Shenouda G, Bar-Ad V, Waldron JN, Harari PM, Raben A, Torres-Saavedra P, Le QT. Long-term Outcomes of Bevacizumab and Chemoradiation for Locoregionally Advanced Nasopharyngeal Carcinoma: A Nonrandomized Controlled Trial. JAMA Netw Open. 2023 Jun 1;6(6):e2316094. doi: 10.1001/jamanetworkopen.2023.16094.

Reference Type DERIVED
PMID: 37266942 (View on PubMed)

Lee NY, Zhang Q, Pfister DG, Kim J, Garden AS, Mechalakos J, Hu K, Le QT, Colevas AD, Glisson BS, Chan AT, Ang KK. Addition of bevacizumab to standard chemoradiation for locoregionally advanced nasopharyngeal carcinoma (RTOG 0615): a phase 2 multi-institutional trial. Lancet Oncol. 2012 Feb;13(2):172-80. doi: 10.1016/S1470-2045(11)70303-5. Epub 2011 Dec 15.

Reference Type DERIVED
PMID: 22178121 (View on PubMed)

Other Identifiers

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NCI-2009-00736

Identifier Type: REGISTRY

Identifier Source: secondary_id

RTOG-0615

Identifier Type: -

Identifier Source: secondary_id

CDR0000518526

Identifier Type: -

Identifier Source: secondary_id

RTOG 0615

Identifier Type: OTHER

Identifier Source: secondary_id

RTOG-0615

Identifier Type: OTHER

Identifier Source: secondary_id

U10CA021661

Identifier Type: NIH

Identifier Source: secondary_id

View Link

NCI-2009-00736

Identifier Type: -

Identifier Source: org_study_id

NCT00707096

Identifier Type: -

Identifier Source: nct_alias

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