Cisplatin and Intensity-Modulated Radiation Therapy in Treating Patients with Locally Advanced Head and Neck Squamous Cell Carcinoma
This randomized phase II trial studies the side effects of cisplatin and radiation therapy and to see how well they work in treating patients with head and neck squamous cell carcinoma that has spread from where it started to nearby tissue or lymph nodes. Drugs used in chemotherapy, such as cisplatin, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Intensity-modulated radiation therapy uses high energy x-rays to kill tumor cells and shrink tumors. Giving cisplatin and intensity-modulated radiation therapy may work better in treating patients with head and neck squamous cell carcinoma.
Inclusion Criteria
- Patients must have pathologically (histologically or cytologically) proven diagnosis of head and neck squamous cell carcinoma (HNSCC) involving the oral cavity, oropharynx, larynx, hypopharynx, paranasal sinuses or unknown primary squamous carcinoma limited to the head and neck region * Cohort 1: unresectable locally advanced non-nasopharyngeal squamous cell carcinoma of the head and neck (SCCHN) without evidence of distant metastases * Cohort 2: patients with non-nasopharyngeal SCCHN who have undergone gross total surgical resection within 63 days prior to registration; patients must have at least 1 of the following high-risk pathologic features: extracapsular nodal extension, invasive cancer at the primary tumor resection margin (positive margin), lymphovascular invasion or perineural invasion, or the presence of multilevel nodal disease; patients must be without evidence of distant metastases
- Women of childbearing potential and male participants who are sexually active must agree to use a medically effective means of birth control
- COHORT 1: Patients in cohort 1 must have measurable disease, defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded for non-nodal lesions and short axis for nodal lesions) as >= 20 mm (>= 2 cm) with conventional techniques or as >= 10 mm (>= 1 cm) with spiral computed tomography (CT) scan, magnetic resonance imaging (MRI), or calipers by clinical exam
- COHORT 2: Subjects in the post-operative setting (cohort 2) are not required to have measurable disease and response rate will not be assessed in cohort 2
- Patients may have a history of prior head and neck malignancy, but must be able to tolerate full dose radiation and chemotherapy for the current head and neck cancer, as determined by the treating oncologist
- Eastern Cooperative Oncology Group (ECOG) performance status 0, 1 or 2
- Life expectancy of greater than 12 weeks
- Absolute neutrophil count >= 1,000/mcL, assessed within 14 days prior to registration
- Platelets >= 100,000/mcL, assessed within 14 days prior to registration
- Creatinine within normal institutional limits, assessed within 14 days prior to registration OR
- Creatinine clearance >= 60 mL/min/1.73 m^2 for patients with creatinine levels above institutional normal, assessed within 14 days prior to registration
- No prior chemotherapy for the current locally advanced SCCHN is allowed; prior radiation or chemotherapy for a previous head and neck cancer is allowed provided full dose cisplatin and radiation can be delivered to the patient in this clinical trial and provided the patient is in remission from the prior head and neck cancer, and can undergo full dose radiation and chemotherapy for the current primary head and neck cancer
- Women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry, throughout the duration of active treatment and for 4 months after completion of chemotherapy and radiation; should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately; men treated or enrolled on this protocol must also agree to use adequate contraception prior to the study, for the duration of active study treatment, and for 4 months after completion of chemotherapy and radiation (both induction and definitive) administration
- Ability to understand and the willingness to sign a written informed consent document
Exclusion Criteria
- Patients who have had chemotherapy or radiotherapy within 4 weeks (6 weeks for nitrosoureas or mitomycin C) prior to entering the study or those who have not recovered from adverse events due to agents administered more than 4 weeks earlier
- Patients who are receiving any other investigational agents
- History of allergic reactions attributed to compounds of similar chemical or biologic composition to cisplatin
- Patients with greater than grade 2 hearing loss
- No other prior malignancy is allowed except for the following: head and neck cancer in remission, adequately treated basal cell or squamous cell skin cancer, in situ cervical cancer, adequately treated previous stage I or II cancer from which the patient is currently in complete remission or other cancer from which the patient has been disease-free for 2 years
- Patients with nasopharynx or salivary gland primary site
- Patients with distant metastatic disease (M1c) from the current head and neck cancer including brain metastasis
- Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection (grade 3 or greater), symptomatic congestive heart failure, unstable angina pectoris, symptomatic cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements; subjects with significant symptoms of congestive heart failure who would not be expected to tolerate the IV hydration for cisplatin are excluded
- Pregnant women are excluded; breastfeeding should be discontinued if the mother is treated with cisplatin or radiation on this trial
- Human immunodeficiency virus (HIV)-positive patients with uncontrolled HIV despite combination antiretroviral therapy are ineligible
Additional locations may be listed on ClinicalTrials.gov for NCT02994069.
See trial information on ClinicalTrials.gov for a list of participating sites.
PRIMARY OBJECTIVES:
I. Rate of grade 3-5 cisplatin-related adverse events occurring within 90 days of initiation of concurrent radiation and chemotherapy including nausea/vomiting, ototoxicity, nephrotoxicity, neutropenia, and thrombocytopenia.
SECONDARY OBJECTIVES:
I. To compare 2-year local control rates in both populations.
II. To compare overall survival (OS) in both populations.
III. To compare progression free survival (PFS) in both populations.
IV. To compare response rate in both populations.
V. To compare and contrast the development of oxidative stress markers which occur as a result of exposure to weekly or every 3-week doses of cisplatin in this population.
VI. Rates of radiation related Common Terminology Criteria for Adverse Events (CTCAE) adverse events, specifically: mucositis, dysphagia, dry mouth, and skin and their relationships with patient reported outcomes at 3 months and 12 months.
VII. CTCAE acute (< 90 days from start of chemoradiation) adverse events related (possibly, probably or definitely) to cisplatin or radiation.
VIII. CTCAE late (> 90 days from start of chemoradiation) adverse events related (possibly, probably or definitely) to cisplatin or radiation.
IX. Quality of life as measured by Functional Assessment of Cancer Therapy-Head & Neck (FACTHN) and Functional Assessment of Cancer Therapy Cognition (FACTCOG) at baseline, 3, and 12 months from end of radiation therapy (RT).
OUTLINE: Patients are randomized to 1 of 2 arms.
ARM I: Patients receive cisplatin intravenously (IV) over 1 hour on days 1, 22, and 43. Patients also undergo standard of care intensity modulated radiotherapy (IMRT) for 5 fractions a week over 6-7 weeks, for a total of 30-35 fractions.
ARM II: Patients receive cisplatin IV over 1 hour on days 1, 8, 15, 22, 29, 36, and 43. Patients also undergo standard of care IMRT for 5 fractions a week over 6-7 weeks, for a total of 30-35 fractions.
After completion of study treatment, patients are followed up every 6 months for up to 2 years and then periodically for 5 years.
Trial PhasePhase II
Trial Typetreatment
Lead OrganizationUniversity of Kentucky/Markey Cancer Center
Principal InvestigatorSusanne Markesbery Arnold
- Primary IDMCC-16-HN-29
- Secondary IDsNCI-2017-00528
- ClinicalTrials.gov IDNCT02994069