Head and Neck Cancer
Conditions
Keywords
stage III squamous cell carcinoma of the hypopharynx, stage III squamous cell carcinoma of the larynx, stage III verrucous carcinoma of the larynx, stage III squamous cell carcinoma of the oropharynx, stage IV squamous cell carcinoma of the hypopharynx, stage IV squamous cell carcinoma of the larynx, stage IV verrucous carcinoma of the larynx, stage IV squamous cell carcinoma of the oropharynx, stage III verrucous carcinoma of the oral cavity, stage III squamous cell carcinoma of the lip and oral cavity, stage IV verrucous carcinoma of the oral cavity, stage IV squamous cell carcinoma of the lip and oral cavity
Brief summary
RATIONALE: Radiation therapy uses high-energy x-rays to kill tumor cells. Giving radiation therapy in higher doses over a shorter period of time may kill more tumor cells and have fewer side effects. Drugs used in chemotherapy, such as cisplatin, 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 panitumumab, 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. It is not yet known whether giving standard radiation therapy together with high-dose cisplatin is more effective than giving higher-dose radiation therapy together with panitumumab in treating patients with locally advanced head and neck cancer. PURPOSE: This randomized phase III trial is comparing two radiation therapy regimens to see how well they work when given together with cisplatin or panitumumab in treating patients with locally advanced stage III or stage IV head and neck cancer.
Detailed description
OBJECTIVES: Primary * To compare the progression-free survival (PFS) of patients with locally advanced squamous cell carcinoma of the head and neck treated with standard fractionation radiotherapy and high-dose cisplatin vs accelerated fractionation radiotherapy and panitumumab. Secondary * To compare overall survival of patients treated with these regimens. * To compare local and regional PFS of patients treated with these regimens. * To compare distant metastasis in patients treated with these regimens. * To compare adverse events, including late radiotherapy-related adverse events in patients treated with these regimens. * To compare quality of life (QOL) of patients treated with these regimens. * To compare swallowing-related QOL of patients treated with these regimens. * To compare economic evaluation (cost effectiveness analysis and cost utility), including both healthcare utilization and indirect costs. OUTLINE: This is a multicenter study. Patients are stratified according to T category (T1-3 vs T4), nodal status (N0-1 vs N2 vs N3), radiotherapy delivery modality (intensity-modulated \[IMRT\] vs 3-D conformal \[3D CRT\]), anatomic location (hypopharynx vs oral cavity vs oropharynx vs larynx), and participation in the optional swallowing impairment substudy (yes vs no). Patients are randomized to 1 of 2 treatment arms. * Arm I: Patients undergo standard fractionation radiotherapy (IMRT or 3D CRT) once daily, 5 days a week, for 7 weeks. Patients receive cisplatin IV over 1 hour on days 1, 22, and 43 of radiotherapy. * Arm II: Patients undergo accelerated fractionation radiotherapy (IMRT or 3D CRT) once or twice daily, 5 days a week, for 6 weeks. Patients receive panitumumab IV over 30-90 minutes 1 week prior to and on days 15 and 36 of radiotherapy. Treatment in both arms continues in the absence of disease progression or unacceptable toxicity. Quality of life (QOL) (FACT-H&N), swallowing-related QOL (MDADI, SWAL-QOL), swallowing function (FOIS), and economic evaluations (Lost Productivity questionnaire) are assessed periodically during the study. After completion of study treatment, patients are followed periodically for at least 5 years.
Interventions
BIOLOGICALpanitumumab
Given IV
DRUGcisplatin
Given IV
RADIATION3-dimensional conformal radiation therapy
Patients undergo radiotherapy
RADIATIONaccelerated radiation therapy
Patients undergo accelerated fractionation radiotherapy
RADIATIONintensity-modulated radiation therapy
Patients undergo radiotherapy
Sponsors
NCIC Clinical Trials Group
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
DISEASE CHARACTERISTICS: * Histologically and/or cytologically confirmed (primary lesion or regional lymph nodes) squamous cell carcinoma of the oral cavity, oropharynx, larynx, or hypopharynx * Locally advanced disease, defined by any of the following criteria: * Any T, N+, M0 * T3-4, N0, M0 * No current history of unknown primary squamous cell carcinoma of the head and neck, primary nasopharyngeal, paranasal, or salivary gland tumors of the head and neck PATIENT CHARACTERISTICS: * ECOG performance status 0-1 * Absolute granulocyte count ≥ 1.5 x 10\^9/L * Platelet count ≥ 100 x 10\^9/L * Bilirubin ≤ 1.5 times upper limit of normal (ULN) * AST or ALT ≤ 3 times ULN * Creatinine clearance \> 50 mL/min * Magnesium \> 0.5 mmol/L * Not pregnant or nursing * Negative pregnancy test * Fertile patients must use effective contraception during and for ≥ 6 months after completion of study treatment * Must be accessible for treatment and follow-up * Able (sufficiently fluent) and willing to complete the quality of life (QOL) and swallowing QOL questionnaires in either English or French * Must be assessed by a radiation oncologist and medical oncologist and deemed suitable for study participation * No other malignancies within the past 5 years, except adequately treated nonmelanoma skin cancer, curatively treated in-situ cancer of the cervix, or other curatively treated solid tumors * No history of allergic or hypersensitivity reactions to any of the study drugs or their excipients * No prior or concurrent interstitial lung disease (e.g., pneumonitis or pulmonary fibrosis) on baseline CT scan * No peripheral neuropathy ≥ grade 2 (CTCAE v3.0) * No hearing loss/tinnitus ≥ grade 3 (CTCAE v3.0) * No thromboembolic event within the past 12 months despite being treated with anticoagulation drugs * Prior thromboembolic event \> 12 months allowed provided patient is stable on anticoagulation or on preventative anticoagulation * None of the following allowed: * Myocardial infarction within the past 12 months * Uncontrolled severe congestive heart failure * Unstable angina * Active cardiomyopathy * Unstable ventricular arrhythmia * Uncontrolled hypertension * Uncontrolled psychiatric disorder * Active serious infection * Active peptic ulcer disease * Any other medical condition that might interfere with protocol therapy delivery PRIOR CONCURRENT THERAPY: * No prior surgical treatment except diagnostic biopsy for this disease * No prior induction chemotherapy for this disease * No prior radiation to the head and neck region that would result in overlap of fields for this study * No prior cisplatin or carboplatin chemotherapy * No prior targeted anti-EGFR therapy of any kind * At least 30 days since any prior investigational agent * No concurrent granulocytic growth factors (e.g., filgrastim \[G-CSF\]) during radiotherapy * No concurrent erythropoietic growth factors, pilocarpine, amifostine, other anticancer therapy (e.g., cytotoxic agents, biological response modifiers, immunotherapy, or hormonal therapy), or other investigational drug therapy * The following radiological investigations must be done within 8 weeks of randomization: * MRI or CT of the head and neck * CT chest
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Progression-free Survival (PFS) Rate | 6.2 years | The progression event is defined by first event of the following, Local-regional progression or recurrence Distant metastasis Non-protocol RT, chemotherapy, or biologic therapy without documentation of the site of failure Surgery of primary site with tumour present/unknown Neck dissection with tumour present/unknown, \> 15 weeks from end of RT Death due to study cancer or from unknown causes or any other reason Number of patients with and without progression event will be reported. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Overall Survival Rate | 6.2 years | Overall survival is defined as the time interval between the date of randomization to date of death from any cause (calculated in months). Otherwise, survival is censored at the last date that the patient is known to be alive. Number of death and alive patients will be reported. |
Countries
Canada
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Cisplatin Patients undergo standard fractionation radiotherapy (IMRT or 3D CRT) once daily, 5 days a week, for 7 weeks. Patients receive cisplatin IV over 1 hour on days 1, 22, and 43 of radiotherapy.
cisplatin: Given IV
3-dimensional conformal radiation therapy: Patients undergo radiotherapy
intensity-modulated radiation therapy: Patients undergo radiotherapy | 160 |
| Panitumumab Patients undergo accelerated fractionation radiotherapy (IMRT or 3D CRT) once or twice daily, 5 days a week, for 6 weeks. Patients receive panitumumab IV over 30-90 minutes 1 week prior to and on days 15 and 36 of radiotherapy.
panitumumab: Given IV
3-dimensional conformal radiation therapy: Patients undergo radiotherapy
accelerated radiation therapy: Patients undergo accelerated fractionation radiotherapy
intensity-modulated radiation therapy: Patients undergo radiotherapy | 160 |
| Total | 320 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | No treated | 4 | 1 |
Baseline characteristics
| Characteristic | Total | Cisplatin | Panitumumab |
|---|---|---|---|
| Age, Continuous | 56.54 years STANDARD_DEVIATION 7.46 | 56.68 years STANDARD_DEVIATION 7.5 | 56.40 years STANDARD_DEVIATION 7.43 |
| Anatomic Location Hypopharynx | 19 Participants | 8 Participants | 11 Participants |
| Anatomic Location Larynx | 35 Participants | 18 Participants | 17 Participants |
| Anatomic Location Oral Cavity | 7 Participants | 2 Participants | 5 Participants |
| Anatomic Location Oropharynx | 259 Participants | 132 Participants | 127 Participants |
| ECOG Performance Status 0 | 226 Participants | 111 Participants | 115 Participants |
| ECOG Performance Status 1 | 94 Participants | 49 Participants | 45 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 1 Participants | 0 Participants | 1 Participants |
| Race (NIH/OMB) Asian | 8 Participants | 1 Participants | 7 Participants |
| Race (NIH/OMB) Black or African American | 3 Participants | 1 Participants | 2 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 308 Participants | 158 Participants | 150 Participants |
| Sex: Female, Male Female | 52 Participants | 26 Participants | 26 Participants |
| Sex: Female, Male Male | 268 Participants | 134 Participants | 134 Participants |
| Smoking No | 91 Participants | 47 Participants | 44 Participants |
| Smoking Yes | 229 Participants | 113 Participants | 116 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 43 / 160 | 32 / 160 |
| other Total, other adverse events | 156 / 156 | 159 / 159 |
| serious Total, serious adverse events | 0 / 156 | 0 / 159 |
Outcome results
Primary
Progression-free Survival (PFS) Rate
The progression event is defined by first event of the following, Local-regional progression or recurrence Distant metastasis Non-protocol RT, chemotherapy, or biologic therapy without documentation of the site of failure Surgery of primary site with tumour present/unknown Neck dissection with tumour present/unknown, \> 15 weeks from end of RT Death due to study cancer or from unknown causes or any other reason Number of patients with and without progression event will be reported.
Time frame: 6.2 years
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Cisplatin | Progression-free Survival (PFS) Rate | PFS event | 50 Participants |
| Cisplatin | Progression-free Survival (PFS) Rate | no PFS event | 110 Participants |
| Panitumumab | Progression-free Survival (PFS) Rate | PFS event | 43 Participants |
| Panitumumab | Progression-free Survival (PFS) Rate | no PFS event | 117 Participants |
Comparison: The log rank test stratified by the stratification factors at randomization was used to compare the difference in PFS between two treatment arms.p-value: 0.8395% CI: [0.6, 1.5]Regression, Cox
Secondary
Overall Survival Rate
Overall survival is defined as the time interval between the date of randomization to date of death from any cause (calculated in months). Otherwise, survival is censored at the last date that the patient is known to be alive. Number of death and alive patients will be reported.
Time frame: 6.2 years
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Cisplatin | Overall Survival Rate | Death | 43 Participants |
| Cisplatin | Overall Survival Rate | Alive | 117 Participants |
| Panitumumab | Overall Survival Rate | Death | 32 Participants |
| Panitumumab | Overall Survival Rate | Alive | 128 Participants |
p-value: 0.6695% CI: [0.54, 1.48]Log Rank