A Randomized, Phase II Study of Definitive Radiotherapy With Concurrent Cisplatin vs. Docetaxel-cetuximab in Locally Advanced Head and Neck Squamous Cell Carcinoma: an ERCC1 Biomarker Enrichment and Interaction Design
Summary
The goal of this clinical research study is to learn which chemotherapy combination may be more effective in treating locally advanced head and neck squamous cell carcinoma (HNSCC). The side effects of these combinations will also be studied. This study treatment consists of intensity-modulated radiation therapy (IMRT) and concurrent chemotherapy. For study chemotherapy, patients will be randomized between cisplatin or the combination of docetaxel and cetuximab. Subjects will be stratified depending on HPV status and the presence of ERCC-1 \[4F9\] in the tumor prior to randomization. The study will evaluate cisplatin vs. docetaxel-cetuximab in the overall population, and test which radiation and chemotherapy combination works best in relationship to how much ERCC-1 \[4F9\] is expressed in a tumor.
Detailed description
If randomized to the cisplatin arm, patients receive cisplatin, 40 mg/m2, administered intravenously (IV) once a week (+/- 2 days) for 7 weeks. Per investigator discretion, if radiation continues beyond 7 weeks due to technical factors (not toxicity delays), an 8th dose of concurrent cisplatin may be added. Cisplatin can be given either before or after the radiation therapy fraction that is given on the same day. If a dose of cisplatin is omitted when radiotherapy is ongoing, it will not be made up or added to the end of treatment. The omitted dose and the reason for the omission should be recorded in the site's source documentation. If radiotherapy is held, cisplatin should be held during the treatment break and resumed when radiation restarts. Patients randomized to Cetuximab arm receive cetuximab, 250 mg/m2, IV over 60 minutes on a weekly schedule (+/- 2 days). . Cetuximab may be administered either before or after the radiation fraction that is given on the same day. Docetaxel will be administered at least 30 minutes following cetuximab. It is not permitted to make up missed doses of cetuximab or docetaxel. If a radiation therapy treatment break occurs, cetuximab should be held. When radiation restarts, cetuximab should resume. Cetuximab will be given once a week (+/- 2 days) for a total of 7 doses concurrent with radiation therapy and docetaxel.
Arms & interventions
- DrugCisplatin
Cisplatin 40 mg/m2 weekly x 7
- RadiationIMRT
IMRT: once daily, M-F, 7 weeks (70 Gy)
- DrugDocetaxel
Docetaxel 15 mg/m2 weekly x 7
- DrugCetuximab
Cetuximab 400 mg/m2 load, one week prior to IMRT Cetuximab 250 mg/m2 weekly x 7
Outcome measures
Primary
Time To Progression (TTP)
Time To Progression is the duration of time from date of study entry until the first appearance of new metastatic lesions or objective tumor progression in patients with increased tumoral ERCC1 expression. Progression is defined per RECIST v1.1 as at least a 20% increase in the sum of diameters of target lesions, taking as reference the smallest sum on study (this includes the baseline sum if that is the smallest on study). In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5 mm. (Note: the appearance of one or more new lesions is also considered progression).
Time frame: Up to 5 years
Secondary
Time to progression (TTP)
Time frame: Up to 5 years
Local Control Rate (LRC)
Time frame: Up to 5 years
Rate of distant metastases
Time frame: Up to 5 years
Validation candidate cutpoint
Time frame: Up to 5 years
Response per RECIST 1.1
Time frame: Up to 5 years
2-year (Time to Progression) TTP
Time frame: At 2 years
FACT-H&N FACT - Head & Neck
Time frame: Up to 2 years
Functional Assessment of Cancer Therapy (FACT-Cog)
Time frame: Up to 2 years
Patient Health Questionnaire (PHQ-9)
Time frame: Up to 2 years
General Anxiety Disorder-7 (GAD-7)
Time frame: Up to 2 years
Modified Edmonton Symptom Assessment System (MESAS)
Time frame: Up to 2 years
Impact of Events Scale - Intrusion (IES-I)
Time frame: Up to 2 years
Disease Related Blame Scale (DBS)
Time frame: Up to 2 years
Perceived Threat Scale (PTS)
Time frame: Up to 2 years
The Brief Pain Inventory
Time frame: Up to 2 years
Eligibility criteria
Study locations (1)
UPMC Hillman Cancer Center - Radiation Oncology
Pittsburgh, Pennsylvania, 15232