A Trial of Adjuvant Chemotherapy in Nasopharyngeal Carcinoma Patients With Residual Epstein-Barr Virus (EBV) DNA Following Radiotherapy

February 15, 2022 updated by: Edwin P Hui, Chinese University of Hong Kong

A Multi-center Prospective Randomized Phase III Trial to Determine the Benefit of Adjuvant Chemotherapy Using Gemcitabine and Cisplatin in Nasopharyngeal Carcinoma Patients With Residual EBV DNA Following Primary Radiotherapy With or Without Concurrent Cisplatin

The purpose of this trial is to study the benefit of adjuvant chemotherapy using gemcitabine and cisplatin in high risk NPC patients with residual EBV DNA following primary radiotherapy with or without concurrent cisplatin.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

  • The standard treatment for nasopharynx cancer is a course of radiotherapy with or without concurrent chemotherapy. This will cure about 80% of patients. For the 20% who developed recurrence or metastases, the prognosis is poor.
  • Elevated EBV-DNA in plasma at end of radiotherapy has been shown to predict disease recurrence and may be a marker of subclinical residual disease.
  • This study aims to test whether adjuvant treatment with 6 cycles of a modern chemotherapy regimen (gemcitabine and cisplatin combination) can improve the survival of these high risk patients of nasopharynx cancer who have elevated EBV-DNA after completion of their radiotherapy.

Study Type

Interventional

Enrollment (Actual)

104

Phase

  • Phase 3

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Hong Kong
      • Hong Kong, Hong Kong
        • Department of Clinical Oncology, Queen Mary Hospital
      • Hong Kong, Hong Kong
        • Department of Clinical Oncology, Prince of Wales Hospital
      • Hong Kong, Hong Kong
        • Department of Clinical Oncology, Tuen Mun Hospital
      • Hong Kong, Hong Kong
        • Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital
      • Hong Kong, Hong Kong
        • Department of Clinical Oncology, Queen Elizabeth Hospital
      • Hong Kong, Hong Kong
        • Department of Oncology, Princess Margaret Hospital

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

16 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  1. Have given written informed consent, prior to pre-study screening, with the understanding that consent may be withdrawn at any time without prejudice.
  2. A histological diagnosis of nasopharyngeal cancer (NPC) must have been established at some time and the investigator must review and confirm the diagnosis prior to randomization.
  3. Loco-regional advanced NPC UICC/AJCC Stages IIB, III, IVA or IVB.
  4. No evidence of distant metastases in the staging work up at diagnosis.
  5. Must have detectable plasma EBV-DNA (> 0 copies/ml) at 6-8 weeks after completion of primary RT or chemo-RT
  6. No clinical evidence of persistent loco-regional disease after primary treatment
  7. Performance status of ECOG grade 0 or 1.

  8. Patients must have adequate organ and marrow function as defined below:

    leukocytes >3,000/L; absolute neutrophil count >1,500/L; platelets >100,000/L; total bilirubin <1.5 X institutional upper limit of normal; AST(SGOT)/ALT(SGPT) <2.5 X institutional upper limit of normal; Creatinine clearance > 50 ml/min

  9. At least 18 years of age, of either sex.
  10. If female, must be either (i) post-menopausal or surgically sterilized, or (ii) use a hormonal contraceptive, intra-uterine device, diaphragm with spermicide for the duration of the study and must be neither pregnant nor breast-feeding.

Exclusion Criteria:

  1. Hypercalcaemia: calcium >= 2.7 mmol/L (10.8 mg/dL).
  2. Second primary malignancy (except in situ carcinoma of the cervix or adequately treated basal cell carcinoma of the skin).
  3. More that 12 weeks after completion of primary radiotherapy.
  4. Had received prior adjuvant chemotherapy.
  5. Other serious concomitant systemic disorders incompatible with the study (at the discretion of the investigator).
  6. Have serious active infection.
  7. Patients with peripheral or ototoxicity with a grade of greater than 2.
  8. Pregnant or lactating female subjects and subjects with reproductive potential not implementing adequate contraceptive measures.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: A
Adjuvant chemotherapy and then clinical follow-up and surveillance
Drug: Adjuvant chemotherapy (gemcitabine and cisplatin)
Gemcitabine 1000 mg/m2 in 250 ml NS over 30 mins IV on Day 1 and 8 Cisplatin 40 mg/m2 in 1L NS over 2 h IV on Day 1 and 8 Cycle repeated every 3 weeks for total of 6 cycles
No Intervention: B
Clinical follow-up and surveillance only

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Time Frame
Relapse free survival
Time Frame: 5 years
5 years

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Overall survival
Time Frame: 5 years
Overall survival is defined as the duration from the date of randomization to the date of death due to all causes or censored at the date of last follow-up
5 years
Loco-regional control
Time Frame: 5 years
5 years
Metastasis-free survival
Time Frame: 5 years
5 years
Toxicity of adjuvant chemotherapy
Time Frame: 6 months
6 months
Correlation of plasma EBV DNA and PET/CT scan with clinical course and outcome
Time Frame: 5 years
5 years

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Chinese University of Hong Kong

Collaborators

Hong Kong Nasopharyngeal Cancer Study Group Limited

Investigators

  • Principal Investigator: Anthony TC Chan, MD, FRCP, Department of Clinical Oncology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
  • Principal Investigator: Roger KC Ngan, FRCR, Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

September 4, 2006

Primary Completion (Actual)

October 26, 2021

Study Completion (Actual)

October 26, 2021

Study Registration Dates

First Submitted

August 30, 2006

First Submitted That Met QC Criteria

August 30, 2006

First Posted (Estimate)

September 1, 2006

Study Record Updates

Last Update Posted (Actual)

February 17, 2022

Last Update Submitted That Met QC Criteria

February 15, 2022

Last Verified

February 1, 2022

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • HKNPCSG 0502

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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