Studie srovnávající personalizovanou radiační terapii se standardní radiační terapií u lidí s HPV-pozitivní rakovinou hrdla
Randomizovaná a dvojitě zaslepená studie fáze III s deeskalovanou radiací u FMISO PET s dobrým rizikem versus standardní péče ozáření u neselektovaného HPV pozitivního orofaryngeálního karcinomu
The researchers are doing this study to find out if a personalized approach to chemoradiation therapy (which may include a lower dose of radiation) is as effective as the standard chemoradiation therapy in people with HPV-positive throat cancer. Other purposes of this study include looking at the following:
- Whether a lower dose of radiation in combination with standard chemotherapy causes fewer side effects than the standard dose of radiation therapy in combination with standard chemotherapy
- How the study approaches (lower dose of radiation therapy + standard chemotherapy and standard dose of radiation therapy + standard chemotherapy) affect participants' quality of life. The researchers will measure quality of life by having participants fill out questionnaires.
Přehled studie
Postavení
Typ studie
Zápis (Odhadovaný)
Fáze
- Fáze 3
Kontakty a umístění
Studijní kontakt
- Jméno: Nancy Lee, MD
- Telefonní číslo: 212-639-3341
- E-mail: leen2@mskcc.org
Studijní záloha kontaktů
- Jméno: Nadeem Riaz, MD
- Telefonní číslo: 646-888-3495
Studijní místa
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Connecticut
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Hartford, Connecticut, Spojené státy, 06102
- Nábor
- Hartford Healthcare (Data Collection Only)
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Kontakt:
- Charles Rutter, MD
- Telefonní číslo: 860-972-2803
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Florida
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Miami, Florida, Spojené státy, 33143
- Nábor
- Baptist Alliance MCI (Data Collection Only)
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Kontakt:
- Noah Kalman, MD
- Telefonní číslo: 786-596-2000
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New Jersey
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Basking Ridge, New Jersey, Spojené státy, 07920
- Nábor
- Memorial Sloan Kettering Basking Ridge (Limited Protocol Activities)
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Kontakt:
- Nancy Lee, MD
- Telefonní číslo: 212-639-3341
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Middletown, New Jersey, Spojené státy, 07748
- Nábor
- Memorial Sloan Kettering Monmouth (Limited Protocol Activities)
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Kontakt:
- Nancy Lee, MD
- Telefonní číslo: 212-639-3341
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Montvale, New Jersey, Spojené státy, 07645
- Nábor
- Memorial Sloan Kettering Bergen (Limited Protocol Activities)
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Kontakt:
- Nancy Lee, MD
- Telefonní číslo: 212-639-3341
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New York
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Commack, New York, Spojené státy, 11725
- Nábor
- Memorial Sloan Kettering Suffolk- Commack (Limited Protocol Activities)
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Kontakt:
- Nancy Lee, MD
- Telefonní číslo: 212-639-3341
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Harrison, New York, Spojené státy, 10604
- Nábor
- Memorial Sloan Kettering Westchester (Limited Protocol Activities)
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Kontakt:
- Nancy Lee, MD
- Telefonní číslo: 212-639-3341
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New York, New York, Spojené státy, 10065
- Nábor
- Memorial Sloan Kettering Cancer Center (All Protocol Activities)
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Kontakt:
- Nancy Lee, MD
- Telefonní číslo: 212-639-3341
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Uniondale, New York, Spojené státy, 11553
- Nábor
- Memorial Sloan Kettering Nassau (Limited Protocol Activities)
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Kontakt:
- Nancy Lee, MD
- Telefonní číslo: 212-639-3341
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Kritéria účasti
Kritéria způsobilosti
Věk způsobilý ke studiu
Přijímá zdravé dobrovolníky
Pohlaví způsobilá ke studiu
Popis
Inclusion Criteria:
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Pathologically (histologically or cytologically) proven diagnosis of HPV associated squamous cell carcinoma of the oropharynx (tonsil, base of tongue, or oropharyngeal walls) or squamous cell carcinoma with an unknown primary. Surgical removal of primary site is allowed.
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Patients must test positive for both p16 expression (70% nuclear and cytoplasm expression; Ventana Medical Systems) and mRNA HPV in situ hybridization (RNAscope® 2.5 HD Reagent kit (Advanced Cell Diagnostics, Inc, Hayward, CA). Any CLIA certified testing method can be used.
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Clinical stage Tx-2, N1-2c (AJCC, 7th ed.) without evidence of distant metastasis based on FDG PET/CT.
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ECOG Performance Status of 0-1 or KPS >/=70
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Age ≥ 18
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Adequate hematologic function within 30 days prior to registration, defined as follows:
- White Blood Count (WBC) ≥ 2 K/mcL
- Absolute neutrophil count (ANC) ≥ 1,500 cells/mm^3
- Platelets ≥ 100,000 cells/mm^3
- Hemoglobin ≥ 10.0 g/dl
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Adequate renal function within 30 days prior to registration, defined as follows:
o Serum creatinine < 1.5 mg/dl or creatinine clearance (CC) ≥ 50 ml/min determined by 24-hour collection or estimated by Cockcroft-Gault formula: CCr male = [(140 - age) x (wt in kg)] [(Serum Cr mg/dl) x (72)] CCr female = 0.85 x (CrCl male)
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Negative serum pregnancy test within 14 days prior to registration for women of childbearing potential
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The patient must provide study-specific informed consent prior to study entry
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Optional section of the protocol: Patients must be able to undergo MRI scans, i.e. not claustrophobic
Exclusion Criteria:
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Patients with prior head and neck radiation therapy where there is >30% overlap with the current head and neck radiation fields. Exceptions can be made if determined by the PI/Co-PI that the patient can proceed with protocol activities
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Patients whose tumors are borderline T4 based on anterior tumor extension to the extrinsic muscles of the tongue
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Patients with simultaneous primary cancers outside of the oropharynx
o Note: Exceptions can be made for patients with simultaneous primaries outside the oropharynx if determined by the PI/Co-PI the patient can proceed with protocol activities
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Prior invasive malignancy (except non-melanomatous skin cancer) unless disease free for 3 years or if cure rate from treatment at 5 years to be 90% or greater
o Note: Exceptions can be made for patients with prior malignancies outside the oropharynx if determined by the PI/Co-PI the patient can proceed with protocol activities.
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Prior systemic chemotherapy for the study cancer; note that prior chemotherapy for a different cancer is allowable
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No particle therapy
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Patients who are deemed non-compliant to all the protocol related activities
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Contraindications to receive either cisplatin or the combination of carboplatin/5-fluorouracil at the prescribed doses.
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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
Studijní plán
Jak je studie koncipována?
Detaily designu
- Primární účel: Léčba
- Přidělení: Randomizované
- Intervenční model: Paralelní přiřazení
- Maskování: Dvojnásobek
Zbraně a zásahy
Skupina účastníků / Arm |
Intervence / Léčba |
|---|---|
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Experimentální: Personalized Chemoradiation Therapy
Patient without evidence of hypoxia will receive 30Gy in 2Gy per fraction. Concurrent chemotherapy will be given as per guidelines. After completion of chemotherapy and radiation therapy, a 4 month (+/- 4 weeks) posttreatment standard FDG PET/CT scan will be performed and if there is persistent disease, standard neck dissection will be performed. Further standard of care will be given pending pathologic findings.1. Hypoxia negative: The entire target volume which includes GTV and CTV will receive 30Gy in 2 Gy per fraction over 15 days (PTV30). 2. Hypoxia positive (same as the standard of care): The CTV will receive 50Gy in 2Gy per fraction over 25 days. This is name PTV50 and will receive 50Gy in 2Gy per fraction over 25 days. The GTV will receive an additional boost of 20Gy in 2 Gy per fraction so that the total PTV70 dose is 70Gy. |
Patients will undergo 18F-FMISO scan (only 1 injection) that occurs at week two of radiation treatment, typically day 10 but a window of 8-10 radiation treatment days* after start of radiation is allowed. 30 Gy or 70 Gy of radiation in combination with standard chemotherapy (cisplatin, carboplatin, and 5-FU) 70 Gy of radiation in combination with standard chemotherapy (cisplatin, carboplatin, and 5-FU) EQ-5D-5L (5 questions); 2. MDADI-HN (total of 20 questions); 3. COST-FACIT (total of 12 questions). |
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Aktivní komparátor: Standard Chemoradiation Therapy
Patient will receive 70Gy in 2Gy per fraction regardless of hypoxia status. Concurrent chemotherapy will be given as per guidelines. After completion of chemotherapy and radiation therapy, a 4 month (+/- 4 weeks) posttreatment standard FDG PET/CT scan will be performed and if there is persistent disease, standard neck dissection will be performed. Further standard of care will be given pending pathologic findings. |
Patients will undergo 18F-FMISO scan (only 1 injection) that occurs at week two of radiation treatment, typically day 10 but a window of 8-10 radiation treatment days* after start of radiation is allowed. 30 Gy or 70 Gy of radiation in combination with standard chemotherapy (cisplatin, carboplatin, and 5-FU) 70 Gy of radiation in combination with standard chemotherapy (cisplatin, carboplatin, and 5-FU) EQ-5D-5L (5 questions); 2. MDADI-HN (total of 20 questions); 3. COST-FACIT (total of 12 questions). |
Co je měření studie?
Primární výstupní opatření
Měření výsledku |
Popis opatření |
Časové okno |
|---|---|---|
|
overall survival
Časové okno: 2 years
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The measurement of survival will be evaluated as a time from randomization to events endpoint (i.e., death due to any cause) so that censored data are allowed. To assess the overall survival rate, Kaplan-Meier estimates will be calculated and reported. |
2 years
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Spolupracovníci a vyšetřovatelé
Vyšetřovatelé
- Vrchní vyšetřovatel: Nancy Lee, MD, Memorial Sloan Kettering Cancer Center
Publikace a užitečné odkazy
Užitečné odkazy
Termíny studijních záznamů
Hlavní termíny studia
Začátek studia (Aktuální)
Primární dokončení (Odhadovaný)
Dokončení studie (Odhadovaný)
Termíny zápisu do studia
První předloženo
První předloženo, které splnilo kritéria kontroly kvality
První zveřejněno (Aktuální)
Aktualizace studijních záznamů
Poslední zveřejněná aktualizace (Aktuální)
Odeslaná poslední aktualizace, která splnila kritéria kontroly kvality
Naposledy ověřeno
Více informací
Termíny související s touto studií
Klíčová slova
Další relevantní podmínky MeSH
Další identifikační čísla studie
- 24-200
Plán pro data jednotlivých účastníků (IPD)
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Popis plánu IPD
Memorial Sloan Kettering Cancer Center supports the international committee of medical journal editors (ICMJE) and the ethical obligation of responsible sharing of data from clinical trials. The protocol summary, a statistical summary, and informed consent form will be made available on clinicaltrials.gov when required as a condition of Federal awards, other agreements supporting the research and/or as otherwise required. Requests for deidentified individual participant data can be made beginning 12 months after publication and for up to 36 months post publication. Deidentified individual participant data reported in the manuscript will be shared under the terms of a Data Use Agreement and may only be used for approved proposals. Requests may be made to: crdatashare@mskcc.org
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