- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04444869
Testing Less Intensive Radiation With Chemotherapy to Treat Low-risk Patients With HPV-positive Oropharyngeal Cancer (ENID)
Phase II Trial of Definitive Chemoradiation With Elective Nodal Irradiation Dose De-escalation for p16 Positive Squamous Cell Carcinoma of the Oropharynx "ENID"
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
This is a trial of definitive chemotherapy and radiation therapy in human papilloma virus positive oropharyngeal cancers, in a population whose cancer is thought to be highly radio-sensitive. This is a population whose outcomes are already known to be very good with high rates of local and distant control of the disease. With the long term disease control and survival of patients with this disease, long term treatment toxicity and resulting reduction in quality of life poses new problems. This has lead to several studies to examine the role of radiation dose de-escalation through various strategies in attempt to reduce long term toxicity from treatment and yet achieve equivalent long term disease control.
This trial specifically hypothesizes that a lower dose of radiation therapy to the clinically and radiographically uninvolved lymph nodes will no detrimental effect on loco-regional control or overall survival and will improve the long-term side effect profile, particularly with regards to xerostomia and dysphagia. The goal of this study is therefore to determine whether a lower dose to the clinically and radiographically uninvolved lymph nodes can be done safely and with better long-term toxicity profile and better overall quality of life without compromising the expected outcomes of progression free survival.
Study Type
Enrollment (Estimated)
Phase
- Phase 2
Contacts and Locations
Study Contact
- Name: Joanne Cassani, RN
- Phone Number: 573-882-3677
- Email: cassanij@health.missouri.edu
Study Contact Backup
- Name: Min Cao, RN, MD
- Phone Number: 573-882-9165
- Email: caom@health.missouri.edu
Study Locations
-
-
Missouri
-
Columbia, Missouri, United States, 65203
- Recruiting
- University of Missouri
-
Contact:
- Joanne Cassani, RN, CCRC
- Phone Number: 573-882-3677
- Email: cassanij@health.missouri.edu
-
Contact:
- Ken Baker, RN
- Phone Number: (573) 884-6479
- Email: bakerrk@health.missouri.edu
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Patients generally must have the psychological ability and general health that permits completion of the study requirements and required follow up.
- Women of childbearing potential and men who are sexually active should be willing and able to use medically acceptable forms of contraception throughout the treatment phase of the trial and until at least 60 days following the last study treatment.
- Pathologically (histologically or cytologically) proven diagnosis of squamous cell carcinoma (including the histological variants papillary squamous cell carcinoma and basaloid squamous cell carcinoma) of the oropharynx (tonsil, base of tongue, soft palate, or oropharyngeal walls); cytologic diagnosis from a cervical lymph node is sufficient in the presence of clinical evidence of a primary tumor in the oropharynx. Clinical evidence should be documented, may consist of palpation, imaging, or endoscopic evaluation, and should be sufficient to estimate the size of the primary (for T stage).
- Patients must have clinically or radiographically evident measurable disease at the primary site or at nodal stations. Tonsillectomy or local excision of the primary without removal of nodal disease is permitted, as is excision removing gross nodal disease but with intact primary site. Limited neck dissections retrieving ≤ 4 nodes are permitted and considered as non-therapeutic nodal excisions.
- Immunohistochemical staining for p16 must be performed on tissue and documented in the pathology report(s) with reported result positive for p16.
Clinical stage T1-T3, N0-N2c (AJCC, 7th ed.), which is equal to T1-T3, N0-2 (AJCC, 8th ed.) including no distant metastases based on the following diagnostic workup:
- General history and physical examination within 30 days prior to registration;
- Fiberoptic exam with laryngopharyngoscopy (mirror and/or fiberoptic and/or direct procedure) within 60 days prior to registration;
One of the following combinations of imaging is required within 45 days prior to registration:
- A CT scan of the neck (with contrast) and a chest CT scan (with or without contrast);
- or an MRI of the neck (with contrast) and a chest CT scan (with or without contrast);
- or a CT scan of neck (with contrast) and a PET/CT of neck and chest (with or without contrast);
- or an MRI of the neck (with contrast) and a PET/CT of neck and chest (with or without contrast).
Note: A CT scan of neck and/or a PET/CT performed for the purposes of radiation planning may serve as both staging and planning tools.
- Patients will be asked about their personal smoking history prior to enrollment. Only active smokers with greater than 10 pack years will be excluded from the trial. The total number of pack years will be collected at baseline. Current smokers who wish to discontinue will be offered smoking cessation information, and if they are able to discontinue smoking prior to initiation of radiation therapy, they can remain eligible for the trial.
Number of pack-years = [Frequency of smoking (number of cigarettes per day) × duration of cigarette smoking (years)] / 20 Note: Twenty cigarettes is considered equivalent to one pack. The effect of non-cigarette tobacco products on the survival of patients with p16-positive oropharyngeal cancers is undefined.
- Zubrod Performance Status of 0-1 within 30 days prior to registration;
Adequate hematologic function within 14 days prior to registration, defined as follows:
- Absolute neutrophil count (ANC) ≥ 1,500 cells/mm3;
- Platelets ≥ 100,000 cells/mm3;
- Hemoglobin ≥ 8.0 g/dl; Note: The use of transfusion or other intervention to achieve Hgb ≥ 8.0 g/dl is acceptable.
Adequate renal function within 14 days prior to registration, defined as follows:
- Serum creatinine < 1.5 mg/dl or creatinine clearance (CC) ≥ 50 ml/min
Adequate hepatic function within 14 days prior to registration defined as follows:
- Bilirubin < 2 mg/dl;
- AST or ALT < 3 x the upper limit of normal.
- Negative serum pregnancy test within 14 days prior to registration for women of childbearing potential
Exclusion Criteria:
- Cancers considered to be from an oral cavity site (oral tongue, floor mouth, alveolar ridge, buccal or lip), or the nasopharynx, hypopharynx, or larynx, even if p16 positive;
- Carcinoma of the neck of unknown primary site origin (even if p16 positive);
- T1-T2 N0-1 lateralized squamous cell carcinoma of the tonsil.
- Radiographically matted nodes, that span 6 cm or more; N3 disease
- Supraclavicular nodes, defined as nodes visualized on the same axial imaging slice as the clavicle;
- Definitive clinical or radiologic evidence of metastatic disease or adenopathy below the clavicles;
- Gross total excision of both primary and nodal disease; this includes tonsillectomy, local excision of primary site, and nodal excision that removes all clinically and radiographically evident disease.
- Simultaneous primary cancers or separate bilateral primary tumor sites;
- Prior invasive malignancy (except non-melanomatous skin cancer) unless disease free for a minimum of 5 years (for example, carcinoma in situ of the breast, oral cavity, or cervix are all permissible);
- Prior systemic chemotherapy for the study cancer; note that prior chemotherapy for a different cancer is allowable;
- Prior radiotherapy to the region of the study cancer that would result in overlap of radiation therapy fields;
Severe, active co-morbidity defined as follows:
- Unstable angina and/or congestive heart failure requiring hospitalization within the last 6 months;
- Transmural myocardial infarction within the last 6 months;
- Acute bacterial or fungal infection requiring intravenous antibiotics at the time of registration;
- Chronic Obstructive Pulmonary Disease exacerbation or other respiratory illness requiring hospitalization or precluding study therapy within 30 days of registration;
- Hepatic insufficiency resulting in clinical jaundice and/or coagulation defects; note, however, that laboratory tests for liver function and coagulation parameters are not required for entry into this protocol other than those requested in Section 3.2.11 of the protocol.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Other: Open label single-arm study
All patients will receive concurrent cisplatin and radiation therapy with radiation dose de-escalation to clinically and radiologically uninvolved lymph nodes.
|
Standard dose cisplatin given concurrently with radiation therapy
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Rate of PEG tube placement
Time Frame: During the procedure
|
To determine rate of PEG tube placement
|
During the procedure
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Progression-free survival
Time Frame: Two years post treatment
|
Progression-free survival of 85% or more at measured a 2 years post treatment
|
Two years post treatment
|
Dysphagia index
Time Frame: Baseline, 1 month and 6 months after treatment
|
To report the change in dysphagia using the M. D. Anderson Dysphagia Inventory (MDADI) scores.
Scores are 0 (lowest functioning) to 100 (highest functioning).
|
Baseline, 1 month and 6 months after treatment
|
Patient Reported Outcomes
Time Frame: Baseline and 1, 6, and 12 months after end of treatment
|
European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire
|
Baseline and 1, 6, and 12 months after end of treatment
|
Survival
Time Frame: At 6 months and at 2 years
|
To determine overall survival and progression-free survival
|
At 6 months and at 2 years
|
Toxicity profiles
Time Frame: 1 year and 2 years post treatment
|
Incidence of Common Terminology Criteria for Adverse Events (CTCAE) grade 2 or higher for mucositis, dysphagia, xerostomia and altered taste
|
1 year and 2 years post treatment
|
Hypothyroidism incidence
Time Frame: At 1 and 2 years post treatment
|
To monitor rate of hypothyroidism
|
At 1 and 2 years post treatment
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Gregory Biedermann, MD, University of Missouri - Ellis Fischel Cancer Center
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Neoplasms by Histologic Type
- Neoplasms
- Neoplasms by Site
- Neoplasms, Glandular and Epithelial
- Pharyngeal Neoplasms
- Otorhinolaryngologic Neoplasms
- Pharyngeal Diseases
- Stomatognathic Diseases
- Otorhinolaryngologic Diseases
- Neoplasms, Squamous Cell
- Head and Neck Neoplasms
- Carcinoma
- Carcinoma, Squamous Cell
- Squamous Cell Carcinoma of Head and Neck
- Oropharyngeal Neoplasms
- Antineoplastic Agents
- Cisplatin
Other Study ID Numbers
- 2017520
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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.
Clinical Trials on Oropharynx Cancer
-
Brooke Army Medical CenterCompleted
-
Emory UniversityNational Cancer Institute (NCI); Genentech, Inc.RecruitingOropharynx Cancer, Stage IUnited States
-
Loren Mell, MDMerck Sharp & Dohme LLCRecruitingCancer | Head and Neck Squamous Cell Carcinoma | Oral Cancer | Tumor | Oropharynx Cancer | Cancer of Head and Neck | Oropharyngeal Cancer | Cancer, Advanced | Cancer, Metastatic | Tumor Metastasis | Tumor Recurrence | Tumor Neck | Oropharynx Cancer, Stage III | Oropharynx Cancer, Recurrent | Oropharynx Cancer, MetastaticUnited States
-
Memorial Sloan Kettering Cancer CenterWithdrawn
-
Duke UniversityRecruitingOropharynx CancerUnited States
-
Icahn School of Medicine at Mount SinaiActive, not recruitingLocally Advanced HPV Positive Oropharynx CancerUnited States
-
UNC Lineberger Comprehensive Cancer CenterCompletedHead and Neck Cancer | Oropharynx Cancer | Xerostomia Due to RadiotherapyUnited States
-
University Hospital, Basel, SwitzerlandRecruitingOral Cavity Defect | Oropharynx DefectSwitzerland
-
University of ChicagoNational Cancer Institute (NCI)TerminatedTongue Cancer | Stage I Squamous Cell Carcinoma of the Oropharynx | Stage II Squamous Cell Carcinoma of the Oropharynx | Stage III Squamous Cell Carcinoma of the Oropharynx | Stage IVA Squamous Cell Carcinoma of the OropharynxUnited States
-
Region Örebro CountyVärmland County Council, Sweden; Region Stockholm; Dalarna County Council, Sweden and other collaboratorsActive, not recruitingOropharynx Cancer | Oropharynx Squamous Cell Carcinoma | Base of the Tongue Carcinoma | Tonsillar CancerSweden
Clinical Trials on Cisplatin injection
-
Ain Shams UniversityMisr International UniversityRecruitingNon Small Cell Lung Cancer | Cardiotoxicity | NephropathyEgypt
-
Institut du Cancer de Montpellier - Val d'AurelleActive, not recruiting
-
Chia Tai Tianqing Pharmaceutical Group Co., Ltd.Recruiting
-
Chia Tai Tianqing Pharmaceutical Group Co., Ltd.Not yet recruitingAdvanced Esophageal Squamous Cell CarcinomaChina
-
CSPC ZhongQi Pharmaceutical Technology Co., Ltd.Not yet recruiting
-
Hua LiRecruitingUnresectable Intrahepatic CholangiocarcinomaChina
-
Third Military Medical UniversityRecruitingSmall Cell Lung Cancer | Lung Cancer | SCLC, Extensive StageChina
-
EpicentRx, Inc.Prothex Pharma, Inc.Completed
-
Sun Yat-sen UniversityRecruitingNasopharyngeal CarcinomaChina
-
Jules Bordet InstituteRecruiting