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Clinical Trial Results:
Do Selective Radiation Dose Escalation and Tumor Hypoxia Status Impact the Locoregional Tumor Control after Radiochemotherapy of Head & Neck Tumors?

Summary
EudraCT number
2010-021139-15
Trial protocol
DE  
Global end of trial date
18 Dec 2017

Results information
Results version number
v1(current)
This version publication date
08 Nov 2020
First version publication date
08 Nov 2020
Other versions

Trial information

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Trial identification
Sponsor protocol code
ESC-928-MOL-0000-I
Additional study identifiers
ISRCTN number
-
US NCT number
-
WHO universal trial number (UTN)
-
Sponsors
Sponsor organisation name
Technische Universität München, Fakultät für Medizin
Sponsor organisation address
Ismaninger Str. 22, München, Germany, 81675
Public contact
Dr. med. Steffi Pigorsch, Klinikum rechts der Isar der TU München, Klinik und Poliklinik für RadioOnkologie und Strahlentherap, 0049 8941404501, steffi.pigorsch@mri.tum.de
Scientific contact
Dr. med. Steffi Pigorsch, Klinikum rechts der Isar der TU München, Klinik und Poliklinik für RadioOnkologie und Strahlentherap, 0049 8941404501, steffi.pigorsch@mri.tum.de
Paediatric regulatory details
Is trial part of an agreed paediatric investigation plan (PIP)
No
Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
No
Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
No
Results analysis stage
Analysis stage
Final
Date of interim/final analysis
04 Mar 2020
Is this the analysis of the primary completion data?
Yes
Primary completion date
10 Oct 2017
Global end of trial reached?
Yes
Global end of trial date
18 Dec 2017
Was the trial ended prematurely?
Yes
General information about the trial
Main objective of the trial
Following the requirements of the Bundesamt für Strahlenschutz the primary objective of the pre-study is to assess the occurence of radiogenic toxicities. The main Escalox-trial hypothesizes an improvement in the 2-year loco-regional tumor control and survival in patients of explorative trial arm A in comparison to patients of arm B which undergo standard radiotherapy due to the use of Radiation dose escalation to a sub-volume of the gross tumor volume of locally advanced head and neck cancer in arm A. Primary objective: Does a selective radiation dose escalation to gross Tumor volume improve loco-regional control and survival over 2 years?
Protection of trial subjects
The conduct of this clinical study met all local legal and regulatory requirements. The study was conducted in accordance the ethical principles of Good Clinical Practice (GCP). Participating subjects signed informed consent form and could withdraw from the study at any time without any disadvantage and without having to provide a reason for this decision. The study was regularly monitored by the Sponsor and all investigators connected to the study were GCP trained. The study was approved by the Federal Office for Radiation Protection (BfS) following an application by the sponsor.
Background therapy
The chemotherapy treatment of the Escalox trial will use cisplatin in the 1st and 5th week of the radiotherapy given on 5 days with an absolute dose of 200mg/m².
Evidence for comparator
n.a.
Actual start date of recruitment
17 Jan 2016
Long term follow-up planned
Yes
Long term follow-up rationale
Safety, Efficacy, Scientific research
Long term follow-up duration
5 Years
Independent data monitoring committee (IDMC) involvement?
Yes
Population of trial subjects
Number of subjects enrolled per country
Country: Number of subjects enrolled
Germany: 6
Worldwide total number of subjects
6
EEA total number of subjects
6
Number of subjects enrolled per age group
In utero
0
Preterm newborn - gestational age
0
Newborns (0-27 days)
0
Infants and toddlers (28 days-23 months)
0
Children (2-11 years)
0
Adolescents (12-17 years)
0
Adults (18-64 years)
3
From 65 to 84 years
3
85 years and over
0

Subject disposition

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Recruitment
Recruitment details
Pre-screening processes were in place for all patients. 6 patients were randomised between 17.01.2016 and 10.10.2017. For safety aspects the permisson of the Bfs demanded a pre-study with a 1st step dose-escalation of 2.2 Gy to 77.0 Gy to the GTV with 20 additional patients.

Pre-assignment
Screening details
After the QA-RT approval, patients must have all screening evaluations performed prior to the first dose and must meet all inclusion and none of the exclusion criteria. The patients must be thoroughly informed about all aspects of the study. The first patient was screened in 12/2015; on January 2017 he was enrolled.

Period 1
Period 1 title
per-study stage (overall period)
Is this the baseline period?
Yes
Allocation method
Not applicable
Blinding used
Not blinded

Arms
Arm title
Step one
Arm description
Step one in a stepwise sewiential design
Arm type
Experimental

Investigational medicinal product name
18F-FMISO
Investigational medicinal product code
Other name
MISONIDAZOLE (INN); SUB08997MIG (CAS number); 18-F-MFISO: Fluoromisonidazol - tracer to detect hypoxic cells
Pharmaceutical forms
Injection
Routes of administration
Intravenous use
Dosage and administration details
Total 740 MBq megabecquerel(s)

Number of subjects in period 1
Step one
Started
6
Completed
0
Not completed
6
     premature study termination
6

Baseline characteristics

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Baseline characteristics reporting groups
Reporting group title
per-study stage
Reporting group description
-

Reporting group values
per-study stage Total
Number of subjects
6 6
Age categorical
Units: Subjects
    In utero
0
    Preterm newborn infants (gestational age < 37 wks)
0
    Newborns (0-27 days)
0
    Infants and toddlers (28 days-23 months)
0
    Children (2-11 years)
0
    Adolescents (12-17 years)
0
    Adults (18-64 years)
0
    From 65-84 years
0
    85 years and over
0
Age continuous
Units: years
    median (full range (min-max))
61 (53 to 70) -
Gender categorical
Units: Subjects
    Female
0 0
    Male
6 6
Subject analysis sets

Subject analysis set title
Full analysis set
Subject analysis set type
Full analysis
Subject analysis set description
Includes all patients who entered the study.

Subject analysis sets values
Full analysis set
Number of subjects
6
Age categorical
Units: Subjects
    In utero
    Preterm newborn infants (gestational age < 37 wks)
    Newborns (0-27 days)
    Infants and toddlers (28 days-23 months)
    Children (2-11 years)
    Adolescents (12-17 years)
    Adults (18-64 years)
    From 65-84 years
    85 years and over
Age continuous
Units: years
    median (full range (min-max))
61 (53 to 70)
Gender categorical
Units: Subjects
    Female
0
    Male
6

End points

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End points reporting groups
Reporting group title
Step one
Reporting group description
Step one in a stepwise sewiential design

Subject analysis set title
Full analysis set
Subject analysis set type
Full analysis
Subject analysis set description
Includes all patients who entered the study.

Primary: Radiation-induced toxicity

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End point title
Radiation-induced toxicity [1]
End point description
End point type
Primary
End point timeframe
throughout the study
Notes
[1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
Justification: No statistical testing was planned for the pre-study.
End point values
Step one
Number of subjects analysed
6
Units: Patients
    yes
6
    no
0
No statistical analyses for this end point

Primary: Mean number of radiation-indiced toxicities per patient

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End point title
Mean number of radiation-indiced toxicities per patient [2]
End point description
End point type
Primary
End point timeframe
Throughout the study.
Notes
[2] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
Justification: No statistical testing was planned for the pre-study.
End point values
Step one
Number of subjects analysed
6
Units: number of toxicities
    number (not applicable)
12.5
No statistical analyses for this end point

Secondary: Mean weight loss

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End point title
Mean weight loss
End point description
End point type
Secondary
End point timeframe
throughout the study
End point values
Step one
Number of subjects analysed
6
Units: percent weight/weight
    arithmetic mean (standard deviation)
9.0 ± 2.8
No statistical analyses for this end point

Secondary: Maximum weight loss

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End point title
Maximum weight loss
End point description
End point type
Secondary
End point timeframe
throughout the study
End point values
Step one
Number of subjects analysed
6
Units: percent weight/weight
    arithmetic mean (standard deviation)
15.8 ± 5.9
No statistical analyses for this end point

Secondary: Mean number of late side effects of grade 3

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End point title
Mean number of late side effects of grade 3
End point description
End point type
Secondary
End point timeframe
LENT/SOMA late toxicities
End point values
Step one
Number of subjects analysed
6
Units: number
    number (not applicable)
2.8
No statistical analyses for this end point

Adverse events

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Adverse events information
Timeframe for reporting adverse events
AE Assessment is performed every week during treatment and start of follow-up including acute toxicities according to CTCAE v.4.0. For longterm follow up only late toxicities (according to LENT-SOMA) are assessed.
Assessment type
Systematic
Dictionary used for adverse event reporting
Dictionary name
MedDRA
Dictionary version
18
Reporting groups
Reporting group title
All patients
Reporting group description
All patients who entered the study.

Serious adverse events
All patients
Total subjects affected by serious adverse events
     subjects affected / exposed
6 / 6 (100.00%)
     number of deaths (all causes)
1
     number of deaths resulting from adverse events
1
Injury, poisoning and procedural complications
Gastrointestinal stoma complication
     subjects affected / exposed
1 / 6 (16.67%)
     occurrences causally related to treatment / all
0 / 1
     deaths causally related to treatment / all
0 / 0
Radiation mucositis
     subjects affected / exposed
1 / 6 (16.67%)
     occurrences causally related to treatment / all
1 / 1
     deaths causally related to treatment / all
0 / 0
Surgical and medical procedures
Stoma closure
     subjects affected / exposed
1 / 6 (16.67%)
     occurrences causally related to treatment / all
0 / 1
     deaths causally related to treatment / all
0 / 0
Neoplasms benign, malignant and unspecified (incl cysts and polyps)
Metastases to lymph nodes
     subjects affected / exposed
1 / 6 (16.67%)
     occurrences causally related to treatment / all
0 / 1
     deaths causally related to treatment / all
0 / 0
Non-small cell lung cancer metastatic
     subjects affected / exposed
1 / 6 (16.67%)
     occurrences causally related to treatment / all
0 / 1
     deaths causally related to treatment / all
0 / 1
Cardiac disorders
Atrial fibrillation
     subjects affected / exposed
1 / 6 (16.67%)
     occurrences causally related to treatment / all
0 / 1
     deaths causally related to treatment / all
0 / 0
Respiratory, thoracic and mediastinal disorders
Dyspnoea
     subjects affected / exposed
1 / 6 (16.67%)
     occurrences causally related to treatment / all
0 / 1
     deaths causally related to treatment / all
0 / 0
Pneumonia aspiration
     subjects affected / exposed
1 / 6 (16.67%)
     occurrences causally related to treatment / all
1 / 1
     deaths causally related to treatment / all
0 / 0
Tracheal stenosis
     subjects affected / exposed
1 / 6 (16.67%)
     occurrences causally related to treatment / all
0 / 1
     deaths causally related to treatment / all
0 / 0
Nervous system disorders
Epilepsy
     subjects affected / exposed
1 / 6 (16.67%)
     occurrences causally related to treatment / all
0 / 1
     deaths causally related to treatment / all
0 / 0
Headache
     subjects affected / exposed
1 / 6 (16.67%)
     occurrences causally related to treatment / all
0 / 1
     deaths causally related to treatment / all
0 / 0
General disorders and administration site conditions
Mucosal pain
     subjects affected / exposed
1 / 6 (16.67%)
     occurrences causally related to treatment / all
1 / 1
     deaths causally related to treatment / all
0 / 0
Mucosal ulceration
     subjects affected / exposed
3 / 6 (50.00%)
     occurrences causally related to treatment / all
2 / 3
     deaths causally related to treatment / all
0 / 0
Gastrointestinal disorders
Colitis
     subjects affected / exposed
1 / 6 (16.67%)
     occurrences causally related to treatment / all
0 / 1
     deaths causally related to treatment / all
0 / 0
Diarrhoea haemorrhagic
     subjects affected / exposed
1 / 6 (16.67%)
     occurrences causally related to treatment / all
0 / 1
     deaths causally related to treatment / all
0 / 0
Large intestinal haemorrhage
     subjects affected / exposed
1 / 6 (16.67%)
     occurrences causally related to treatment / all
0 / 1
     deaths causally related to treatment / all
0 / 0
Mouth ulceration
     subjects affected / exposed
1 / 6 (16.67%)
     occurrences causally related to treatment / all
2 / 2
     deaths causally related to treatment / all
0 / 0
Stomatitis
     subjects affected / exposed
4 / 6 (66.67%)
     occurrences causally related to treatment / all
0 / 4
     deaths causally related to treatment / all
0 / 0
Skin and subcutaneous tissue disorders
Skin oedema
     subjects affected / exposed
1 / 6 (16.67%)
     occurrences causally related to treatment / all
0 / 1
     deaths causally related to treatment / all
0 / 0
Metabolism and nutrition disorders
Hyperglycaemia
     subjects affected / exposed
1 / 6 (16.67%)
     occurrences causally related to treatment / all
0 / 1
     deaths causally related to treatment / all
0 / 0
Type 2 diabetes mellitus
     subjects affected / exposed
1 / 6 (16.67%)
     occurrences causally related to treatment / all
0 / 1
     deaths causally related to treatment / all
0 / 0
Infections and infestations
Oral candidiasis
     subjects affected / exposed
1 / 6 (16.67%)
     occurrences causally related to treatment / all
1 / 1
     deaths causally related to treatment / all
0 / 0
Oral infection
     subjects affected / exposed
1 / 6 (16.67%)
     occurrences causally related to treatment / all
1 / 1
     deaths causally related to treatment / all
0 / 0
Superinfection
     subjects affected / exposed
2 / 6 (33.33%)
     occurrences causally related to treatment / all
2 / 2
     deaths causally related to treatment / all
0 / 0
Frequency threshold for reporting non-serious adverse events: 0%
Non-serious adverse events
All patients
Total subjects affected by non serious adverse events
     subjects affected / exposed
6 / 6 (100.00%)
Vascular disorders
Hypertension
     subjects affected / exposed
1 / 6 (16.67%)
     occurrences all number
1
Thrombophlebitis superficial
     subjects affected / exposed
1 / 6 (16.67%)
     occurrences all number
1
Neoplasms benign, malignant and unspecified (incl cysts and polyps)
Gastrointestinal tract adenoma
     subjects affected / exposed
1 / 6 (16.67%)
     occurrences all number
1
General disorders and administration site conditions
Localised oedema
     subjects affected / exposed
3 / 6 (50.00%)
     occurrences all number
3
Mucosal inflammation
     subjects affected / exposed
2 / 6 (33.33%)
     occurrences all number
2
Oedema peripheral
     subjects affected / exposed
1 / 6 (16.67%)
     occurrences all number
1
Pain
     subjects affected / exposed
2 / 6 (33.33%)
     occurrences all number
2
Pyrexia
     subjects affected / exposed
1 / 6 (16.67%)
     occurrences all number
1
Injury, poisoning and procedural complications
Gastrointestinal stoma complication
     subjects affected / exposed
1 / 6 (16.67%)
     occurrences all number
1
Radiation mucositis
     subjects affected / exposed
1 / 6 (16.67%)
     occurrences all number
1
Radiation skin injury
     subjects affected / exposed
5 / 6 (83.33%)
     occurrences all number
5
Investigations
Blood creatine increased
     subjects affected / exposed
2 / 6 (33.33%)
     occurrences all number
3
C-reactive protein increased
     subjects affected / exposed
1 / 6 (16.67%)
     occurrences all number
1
Weight decreased
     subjects affected / exposed
6 / 6 (100.00%)
     occurrences all number
6
Blood and lymphatic system disorders
Anaemia
     subjects affected / exposed
4 / 6 (66.67%)
     occurrences all number
7
Febrile neutropenia
     subjects affected / exposed
1 / 6 (16.67%)
     occurrences all number
1
Leukocytosis
     subjects affected / exposed
1 / 6 (16.67%)
     occurrences all number
1
Leukopenia
     subjects affected / exposed
6 / 6 (100.00%)
     occurrences all number
6
Thrombocytopenia
     subjects affected / exposed
4 / 6 (66.67%)
     occurrences all number
4
Respiratory, thoracic and mediastinal disorders
Cough
     subjects affected / exposed
1 / 6 (16.67%)
     occurrences all number
1
Epistaxis
     subjects affected / exposed
1 / 6 (16.67%)
     occurrences all number
1
Pharyngeal oedema
     subjects affected / exposed
1 / 6 (16.67%)
     occurrences all number
1
Nervous system disorders
Dysgeusia
     subjects affected / exposed
5 / 6 (83.33%)
     occurrences all number
7
Peripheral nerve lesion
     subjects affected / exposed
1 / 6 (16.67%)
     occurrences all number
1
Gastrointestinal disorders
Constipation
     subjects affected / exposed
1 / 6 (16.67%)
     occurrences all number
1
Diarrhoea
     subjects affected / exposed
3 / 6 (50.00%)
     occurrences all number
3
Dry mouth
     subjects affected / exposed
6 / 6 (100.00%)
     occurrences all number
6
Dysphagia
     subjects affected / exposed
6 / 6 (100.00%)
     occurrences all number
7
Flatulence
     subjects affected / exposed
1 / 6 (16.67%)
     occurrences all number
1
Haematochezia
     subjects affected / exposed
1 / 6 (16.67%)
     occurrences all number
1
Mouth ulceration
     subjects affected / exposed
1 / 6 (16.67%)
     occurrences all number
1
Oral dysaesthesia
     subjects affected / exposed
2 / 6 (33.33%)
     occurrences all number
2
Anal haemorrhage
     subjects affected / exposed
1 / 6 (16.67%)
     occurrences all number
1
Odynophagia
     subjects affected / exposed
1 / 6 (16.67%)
     occurrences all number
1
Oral pain
     subjects affected / exposed
3 / 6 (50.00%)
     occurrences all number
3
Vomiting
     subjects affected / exposed
1 / 6 (16.67%)
     occurrences all number
1
Skin and subcutaneous tissue disorders
Dermatitis
     subjects affected / exposed
1 / 6 (16.67%)
     occurrences all number
1
Musculoskeletal and connective tissue disorders
Bone pain
     subjects affected / exposed
1 / 6 (16.67%)
     occurrences all number
1
Myalgia
     subjects affected / exposed
1 / 6 (16.67%)
     occurrences all number
1
Metabolism and nutrition disorders
Hypercalcaemia
     subjects affected / exposed
1 / 6 (16.67%)
     occurrences all number
1
Hypoalbuminaemia
     subjects affected / exposed
1 / 6 (16.67%)
     occurrences all number
1
Hypocalcaemia
     subjects affected / exposed
2 / 6 (33.33%)
     occurrences all number
2
Hypokalaemia
     subjects affected / exposed
1 / 6 (16.67%)
     occurrences all number
1
Hyponatraemia
     subjects affected / exposed
2 / 6 (33.33%)
     occurrences all number
2
Malnutrition
     subjects affected / exposed
1 / 6 (16.67%)
     occurrences all number
1
Infections and infestations
Device related infection
     subjects affected / exposed
3 / 6 (50.00%)
     occurrences all number
6
Herpes zoster
     subjects affected / exposed
1 / 6 (16.67%)
     occurrences all number
1
Influenza
     subjects affected / exposed
1 / 6 (16.67%)
     occurrences all number
1
Mucosal infection
     subjects affected / exposed
2 / 6 (33.33%)
     occurrences all number
2
Oral candidiasis
     subjects affected / exposed
3 / 6 (50.00%)
     occurrences all number
4
Pneumonia
     subjects affected / exposed
3 / 6 (50.00%)
     occurrences all number
3
Skin infection
     subjects affected / exposed
1 / 6 (16.67%)
     occurrences all number
1
Staphylococcal infection
     subjects affected / exposed
1 / 6 (16.67%)
     occurrences all number
1
Superinfection bacterial
     subjects affected / exposed
1 / 6 (16.67%)
     occurrences all number
1
Superinfection fungal
     subjects affected / exposed
1 / 6 (16.67%)
     occurrences all number
1

More information

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Substantial protocol amendments (globally)

Were there any global substantial amendments to the protocol? No

Interruptions (globally)

Were there any global interruptions to the trial? Yes
Date
Interruption
Restart date
23 Aug 2017
Recruitment was stopped (advice SMB): 23.08.2017 before the clinical trial was terminated early (at pre-study stage) by the LKP: 18.12.2017 Because of appearance of early Late-toxicities: 4 out of 6 patients developed extended local mucositis with ulcerations in the initial tumor bed due to radiation dose escalation, trial was interrupted.
-

Limitations and caveats

Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
None reported
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