Docetaxel, Cisplatin, and Fluorouracil Followed By Cetuximab and Radiation Therapy in Treating Patients With Locally Advanced Head and Neck Cancer
Phase II Study to Evaluate the Efficacy and Toxicity of Multimodality Treatment With Induction Taxotere/Cisplatin?5-FU (TPF) Chemotherapy Followed by Concomitant Cetuximab and Radiation Therapy in Patients With Locally Advanced Squamous Cell Carcinoma of the Head and Neck (SCCHN)
RATIONALE: Drugs used in chemotherapy, such as docetaxel, cisplatin, and fluorouracil, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Monoclonal antibodies, such as cetuximab, can block tumor growth in different ways. Some block the ability of tumor cells to grow and spread. Others find tumor cells and help kill them or carry tumor-killing substances to them. Radiation therapy uses high-energy x-rays to kill tumor cells. Giving combination chemotherapy together with cetuximab and radiation therapy may kill more tumor cells.
PURPOSE: This phase II trial is studying how well giving docetaxel, cisplatin, and fluorouracil together with cetuximab and radiation therapy works in treating patients with locally advanced head and neck cancer.
調査の概要
状態
条件
詳細な説明
OBJECTIVES:
Primary
- Evaluate the progression-free survival of patients with locally advanced squamous cell carcinoma of the head and neck treated with induction chemotherapy comprising docetaxel, cisplatin, and fluorouracil followed by concurrent cetuximab and radiotherapy.
Secondary
- Assess the objective response rate in patients treated with this regimen.
- Assess the best overall response rate, overall survival, local-regional control, and distant failure in patients treated with this regimen.
- Assess the acute and long-term toxicity associated with this regimen in these patients.
- Assess quality of life and swallowing in patients treated with this regimen.
- Determine the accuracy of PET/CT scan in evaluating objective response; in detecting residual disease at primary sites and nodes; in guiding the recommendation for salvage surgery or for neck dissection; and in early detection of recurrent or metastatic disease.
OUTLINE: Patients are stratified according to nodal status (N2b-c or N3 vs N0-2a), tumor characteristics of invasiveness (present vs absent), human papilloma virus (HPV) status (positive vs negative), and primary tumor site (hypopharynx vs larynx vs oropharynx).
Patients receive induction chemotherapy comprising docetaxel IV over 1 hour and cisplatin IV over 1 hour on day 1 and fluorouracil IV continuously on days 1-4. Treatment repeats every 3 weeks for up to 3 courses in the absence of disease progression or unacceptable toxicity. Beginning 3-4 weeks after completion of induction chemotherapy, patients receive cetuximab IV once weekly for 7 weeks. Beginning 1 week after the first dose of cetuximab, patients undergo concurrent intensity-modulated radiotherapy or conventional 3-dimensional radiotherapy once or twice daily 5-6 days a week for up to 6 weeks. Patients with persistent disease undergo salvage resection of the primary tumor and/or neck dissection approximately 3 months after the completion of radiotherapy.
Patients undergo quality of life and swallowing evaluations periodically.
Patients undergo PET/CT scan at baseline, before beginning radiotherapy, at 6-8 weeks after completion of study treatment, every 6 months for 5 years, and then annually thereafter.
After completion of study treatment, patients are followed at 4 and 8 weeks, every 2 months for 2 years, every 3 months for 1 year, and then every 6 months thereafter.
研究の種類
入学 (実際)
段階
- フェーズ2
連絡先と場所
研究場所
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North Carolina
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Winston-Salem、North Carolina、アメリカ、27157-1096
- Wake Forest University Comprehensive Cancer Center
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参加基準
適格基準
就学可能な年齢
健康ボランティアの受け入れ
受講資格のある性別
説明
Inclusion:
Histologically confirmed (from primary lesion and/or lymph nodes) squamous cell carcinoma (SCC) of the head and neck, including the following subtypes:
- Oropharynx
- Hypopharynx
- Larynx
Primary site of tumor must not include any of the following:
- Nasopharynx
- Sinuses
- Salivary glands
- Stage III or IV disease that is unresectable (oropharynx, larynx, or hypopharynx) OR that is resectable with organ-sparing goal (oropharynx or hypopharynx)
- Measurable disease by CT scan or MRI
- No definitive evidence of distant metastasis
- ECOG performance status 0-1
- ANC ≥ 1,500/μL
- Platelet count ≥ 100,000/μL
- Hemoglobin ≥ 8 g/dL
Total bilirubin ≤ normal
- Except in the case where the elevated total bilirubin is not a sign of liver disease (i.e., Gilbert syndrome), in which case a total bilirubin ≤ 2 times upper limit of normal (ULN) is allowed provided direct bilirubin is ≤ ULN
AST, ALT, and alkaline phosphate (AP) meeting the following criteria:
- AP normal AND AST or ALT ≤ 5 times upper limit of normal (ULN)
- AP ≤ 2.5 times ULN AND AST or ALT ≤ 1.5 times ULN
- AP ≤ 5 times ULN AND AST or ALT normal
- Creatinine ≤ 1.5 mg/dL
- Negative pregnancy test (for women of childbearing potential)
- Fertile patients must use effective contraception during and for ≥ 3 months after completion of study treatment
- Willing to undergo laryngoscopy with biopsy of residual tumor at primary site (as part of a comprehensive evaluation of tumor response after completion of the induction chemotherapy portion of study treatment)
Exclusion:
- History of severe hypersensitivity reaction to docetaxel or to other drugs formulated with polysorbate 80
- Other invasive malignancy within the past 3 years, except nonmelanoma skin cancer
- Prior allergic reaction to the study drug(s)
Concurrent uncontrolled illness including, but not limited to, any of the following:
- Ongoing or active infection
- Psychiatric illness/social situation that would limit compliance with study requirements
Significant history of uncontrolled cardiac disease, including any of the following:
- Uncontrolled hypertension
- Unstable angina
- Myocardial infarction within the past 6 months
- Uncontrolled congestive heart failure
- Cardiomyopathy with decreased left ventricular ejection fraction (i.e., LVEF < 45%)
- Uncontrolled condition that, in the opinion of the investigator, would interfere in the safe and timely completion of study procedures
- History of interstitial lung disease (e.g., pneumonitis or pulmonary fibrosis) or evidence of interstitial lung disease on screening chest CT scan
- HIV positivity
- Pregnant or nursing
- Prior chemotherapy for the study cancer
- Prior radiotherapy to the region of the study cancer that would result in overlap of radiotherapy fields
- Prior chemotherapy, biological therapy, or hormone therapy within the last one year
- Prior initial surgical treatment, except diagnostic biopsy of the primary site or nodal sampling of neck disease
- Prior radical or modified neck dissection
- Prior therapy that specifically and directly targets the EGFR pathway
- Concurrent investigational agents
研究計画
研究はどのように設計されていますか?
デザインの詳細
- 主な目的:処理
- 割り当て:なし
- 介入モデル:単一グループの割り当て
- マスキング:なし(オープンラベル)
武器と介入
参加者グループ / アーム |
介入・治療 |
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実験的:TPFChemotherapy + Concomitant Cetuximab & RT
Taxotere/Cisplatinum/5-Fluorouracil (TPF) Chemotherapy Followed by Concomitant Cetuximab & Radiation Therapy
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この研究は何を測定していますか?
主要な結果の測定
結果測定 |
時間枠 |
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進行なしのサバイバル
時間枠:2年まで
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2年まで
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二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
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全生存
時間枠:2年まで
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2年まで
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Objective Response Rate
時間枠:up to 2 years
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Will be measured by CT scan /MRI of the head and neck with corroborative results of direct biopsy of any residual tumor at primary site.
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up to 2 years
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Best Overall Response Rate
時間枠:up to 2 years
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Defined as rate of complete and partial responses (at least 30% decrease in the sum of the longest diameter of target lesions), measured by CT scan or MRI of the head and neck after completion of multimodality treatment with induction TPF (Docetaxel, cisplatin and fluorouracil) chemotherapy followed by combined ERT.
We will use RECIST (Response Evaluation Criteria In Solid Tumors) (Therasse et al, 2000) for evaluation of response.
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up to 2 years
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Number of Participants With Distant Metastasis
時間枠:up to 2 years
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up to 2 years
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Quality of Life - Functional Assessment of Cancer Therapy - General (FACT-G)
時間枠:Baseline, pre-radiation therapy and post-radiation therapy, up to 2 years
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Four subscales: physical well-being (PWB; 7-items, score range 0-28), social/family well-being (SWB; 7-items, score range 0-28), emotional well-being (EWB; 6-items, score range 0-24), and functional well-being (FWB; 7-items, score range 0-28).
Items are rated on a five-point scale: 0-"not at all", 1- "a little bit", 2-"somewhat", 3- "quite a bit" and 4-"very much".
Overall quality of life is the sum of the core items of the FACT-G possible range of 0-108 points.
The higher the score the better the quality life.
This interval includes 0, we will conclude that there is not conclusive statistical evidence that there is an improvement or worsening.
If the interval does not include 0 we can determine whether there was a significant improvement (or worsening) depending on which side of the 0 the interval is on.
The total outcome index score (possible range 0-108 points) is the sum of the physical and functional well being and additional concerns categories from the FACT-G.
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Baseline, pre-radiation therapy and post-radiation therapy, up to 2 years
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Number of Participants With Local-Regional Control
時間枠:up to 2 years
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up to 2 years
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Performance Status Scale for Head and Neck Cancer
時間枠:Baseline, pre-radiation therapy and post-radiation therapy, up to 2 years
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Consists of assessment of three functions (subscales): Normalcy of diet, eating in public, and understandability of speech.
The interviewer rates the patient on each scale based on the patient's responses to targeted questions.
Scores range from 0-100 (Full performance (100 score), moderate or severe impairment (≤ 50 score)).
The higher the score, the better the ability of the patient to function.
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Baseline, pre-radiation therapy and post-radiation therapy, up to 2 years
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MD Anderson Dysphagia Inventory
時間枠:Baseline, pre-radiation therapy and post-radiation therapy, up to 2 years
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The MD Anderson Dysphasia Inventory (MDADI) is a survey specifically designed to assess dysphasia.
It contains 20 questions directly addressing the swallowing function and several other general questions.
The questionnaire asks for participants views about their swallowing ability at baseline, pre-radiation therapy and post-radiation therapy.
All questions except for E7 and F2: Strongly Agree = 1 point, Agree = 2 points, No Opinion = 3 points, Disagree = 4 points, Strongly Disagree.
E7 and F2: Strongly agree = 5 points, Agree = 4 points, no opinion = 3 points, disagree = 2 points, strongly disagree = 1 point.
Scores range from 20 (extremely low-functioning) to 100 (high-functioning).
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Baseline, pre-radiation therapy and post-radiation therapy, up to 2 years
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協力者と研究者
捜査官
- 主任研究者:Mercedes Porosnicu, MD、Wake Forest University Health Sciences
研究記録日
主要日程の研究
研究開始
一次修了 (実際)
研究の完了 (実際)
試験登録日
最初に提出
QC基準を満たした最初の提出物
最初の投稿 (見積もり)
学習記録の更新
投稿された最後の更新 (実際)
QC基準を満たした最後の更新が送信されました
最終確認日
詳しくは
本研究に関する用語
キーワード
追加の関連 MeSH 用語
その他の研究ID番号
- IRB00005784
- P30CA012197 (米国 NIH グラント/契約)
- CCCWFU-60108
- CCCWFU-IRB- IRB00005784
- SANOFI-AVENTIS-CCCWFU-60108
医薬品およびデバイス情報、研究文書
米国FDA規制医薬品の研究
米国FDA規制機器製品の研究
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コンピュータ断層撮影の臨床試験
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Emory UniversityNational Cancer Institute (NCI); Blue Earth Diagnostics積極的、募集していない
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Heidelberg Engineering GmbH完了糖尿病を患っていない被験者の正常な目 | DPNを共存させていない2型糖尿病の被験者 | 初期から中等度のDPNを併発する2型糖尿病患者