Human Papillomavirus Infection, Stage III Oropharyngeal Squamous Cell Carcinoma, Stage II Oropharyngeal Squamous Cell Carcinoma, Stage I Oropharyngeal Squamous Cell Carcinoma, Stage IVA Oropharyngeal Squamous Cell Carcinoma, Stage IVB Oropharyngeal Squamous Cell Carcinoma
Conditions
Brief summary
This phase II trial studies how well radiation therapy and docetaxel work in treating patients with human papillomavirus (HPV)-related oropharyngeal cancer. Radiation therapy uses high-energy x-rays to kill tumor cells. Drugs used in chemotherapy, such as docetaxel, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving radiation therapy with docetaxel my kill more tumor cells.
Detailed description
PRIMARY OBJECTIVES: I. To assess the cumulative incidence of local/regional failure at 2 years after study registration. SECONDARY OBJECTIVES: I. To characterize the rate of acute grade 3 or higher functional mucosal adverse events (up to 1 month post-radiation therapy \[XRT\]) associated with adjuvant docetaxel + hyperfractionated radiotherapy (key secondary endpoint). II. To assess changes in overall survival, disease-free survival, distant failure rates, and quality of life (QOL) associated with adjuvant docetaxel and hyperfractionated radiation. III. To characterize other acute adverse events (up to 1 month post-XRT) and late grade 3 or higher non-hematologic adverse events (up to 2 years post-XRT) associated with adjuvant docetaxel + hyperfractionated radiotherapy. TERTIARY OBJECTIVES: I. To determine the genetic alterations of oropharynx tumor specimens and the detection rate of corresponding cell-free deoxyribonucleic acid (cfDNA) in the pre-surgical, post-surgical, and post-radiation blood of oropharynx cancer patients. OUTLINE: Patients receive docetaxel intravenously (IV) over 1 hour on days 1 and 8 and undergo hyperfractionated intensity-modulated radiation therapy (IMRT) twice daily (BID) 5 days a week on days 1-12 for a total of 20 fractions. After completion of study treatment, patients are followed up at 14 days, 1 month, every 3 months for 2 years, every 6 months for 1 year and then annually for 2 years.
Interventions
DRUGDocetaxel
Given IV
RADIATIONHyperfractionation
Undergo hyperfractionated IMRT
RADIATIONIntensity-Modulated Radiation Therapy
Undergo hyperfractionated IMRT
OTHERLaboratory Biomarker Analysis
Correlative studies
OTHERQuality-of-Life Assessment
Ancillary studies
Sponsors
Mayo Clinic
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* PRE-REGISTRATION * Provide written informed consent * Submission of research blood draw to be stored until after surgical resection of the primary tumor and confirmation of human papilloma virus (HPV) positivity (Mayo Clinic Rochester patients only) * Patients with oropharynx carcinoma with a smoking history of ˂ 10 pack-year or equivalent 10 year history of tobacco product use and no recent history (within last 5 years) of tobacco use * REGISTRATION * Histological confirmation of HPV+ squamous cell carcinoma of the oropharynx; HPV positivity will be defined as positive staining for p16 on immunohistochemistry (IHC) * Gross total surgical resection with curative intent of the primary tumor and at least unilateral neck dissection within 7 weeks of registration * Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0 or 1 * Smoking history \< 10 pack years or equivalent 10 year history of tobacco product use * Absence of distant metastases on standard diagnostic work-up =\< 10 weeks prior to registration; (chest computed tomography \[CT\], chest x-ray \[CXR\], positron emission tomography \[PET\]/CT, etc.) * Must have one of the following risk factors: * Lymph node \> 3 cm * 2 or more positive lymph nodes * Perineural invasion * Lymphovascular space invasion * T3 or microscopic T4a primary disease * Lymph node extracapsular extension * Absolute neutrophil count (ANC) \>= 1500/mm\^3 * Platelet count \>= 100,000/mm\^3 * Hemoglobin \>= 9.0 g/dL * Direct bilirubin within upper limit of normal (ULN) * Creatinine =\< ULN x 1.5 * Negative pregnancy test done =\< 7 days prior to registration, for women of childbearing potential only * Ability to complete questionnaire(s) by themselves or with assistance * Provide informed written consent * Willingness to return to enrolling institution for follow-up (during the active monitoring phase of the study)
Exclusion criteria
* Any significant tobacco history within the past five years * Any of the following: * Pregnant women * Nursing women * Men or women of childbearing potential who are unwilling to employ adequate contraception * Co-morbid systemic illnesses or other severe concurrent disease which, in the judgment of the investigator, would make the patient inappropriate for entry into this study or interfere significantly with the proper assessment of safety and toxicity of the prescribed regimens * Immunocompromised patients and patients known to be human immunodeficiency virus (HIV) positive * Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements * Receiving any other investigational agent which would be considered as a treatment for the primary neoplasm * Other active malignancy =\< 5 years prior to registration; EXCEPTIONS: non-melanotic skin cancer or carcinoma-in-situ of the cervix; NOTE: if there is a history or prior malignancy, they must not be receiving other specific treatment for their cancer * History of myocardial infarction =\< 180 days prior to registration, or congestive heart failure requiring use of ongoing maintenance therapy for life-threatening ventricular arrhythmias * Prior history of radiation therapy to the affected site * History of connective tissue disorders such as rheumatoid arthritis, lupus, or Sjogren's disease * Presence of any of the following risk factors after surgery: * Any positive surgical margin * Adenopathy below the clavicles * Prior systemic chemotherapy for the study cancer; NOTE: prior chemotherapy for a different cancer is allowable * History of allergic reaction to docetaxel * Receiving any medications or substances that are strong or moderate inhibitors of cytochrome P450, family 3, subfamily A, polypeptide 4 (CYP3A4) * Use of strong or moderate inhibitors is prohibited =\< 7 days prior to registration * Receiving any medications or substances that are inducers of CYP3A4 * Use of inducers is prohibited =\< 12 days prior to registration
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| 2-year Loco-regional Tumor Control (LRC) Rate | 2 years | The 2-year loco-regional tumor control (LRC) rate (percentage) is defined as the percentage of patients with no local/regional recurrence or death 2 years after study registration. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of Grade 3 or Higher Mucositis Oral | 4 months post-hyperfractionated radiation therapy | The overall percentage of patients experiencing grade 3 or higher mucositis oral graded according to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 are reported below. |
| 2-year Overall Survival (OS) Rate | 2 years | The distribution of OS will be estimated using the method of Kaplan-Meier. |
| 2-year Progression-free Survival (PFS) | From registration to the first of either disease recurrence or death, assessed up to 2 years | The distribution of PFS will be estimated using the method of Kaplan-Meier. |
| 2-year Distant Metastasis-free Survival Rate | 2 years | The 2-year Distant metastasis-free survival rate (percentage) is defined as the percentage of patients with no distant recurrence or death 2 years after study registration. |
| Change From Mean Baseline Score to Mean Score at 12 Months Post-RT in Swallow Function as Measured by the Pharyngeal Total Modified Barium Swallow Impairment Profile. | 12 months | The swallow evaluation consists of a modified barium swallow study(MBS), Functional Oral Intake Scale(FOIS), and Performance Status Scale Head \& Neck(PSS-HN).The 17 swallow questions are rated using a 0 to 5 point scale, with 0 meaning no impairment and 5 max impairment. 6 questions produce a total oral score; scores from 10 questions produce a total pharyngeal score; 1 question produces an esophageal score.The PAS is a validated 8-point scale that ranks the depth of the bolus entry into the airway.A score of 1 indicates no airway entrance;score of 6+ indicate bolus passage past the vocal folds (aspiration).FOIS ranges from 1(nothing by mouth) to 7(total oral diet with no restrictions).PSS-H\&N has 3 components:eating in public(0=always eat alone to 100=no restriction), understandability of speech(0=never understandable, score 100=always understandable), and normalcy of diet(score 0=tube fed to 100=full diet).These scores are summed and normalized to a 0 to 100 scale where 100 is best. |
| Functional Assessment of Cancer Therapy Head and Neck (FACT H& N) (Version 4) | 1 year | The FACT-H\&N is a multidimensional, self-report QOL instrument specifically designed for use with head and neck cancer patients. It consists of 27 core items which assess patient function in four domains: Physical, Social/Family, Emotional, and Functional well-being, in addition to 12 site specific items to assess for head and neck related symptoms. Each item is rated on a 0 to 4 type scale where 4 is favorable and 0 unfavorable, and then combined to produce subscale scores for each domain, as well as a global QOL score- with possible score range from 0 to 156. Higher scores represent better QOL. |
| European Organization for Research and Treatment for Cancer QOL Questionnaire for Head and Neck Cancer Module 35 (EORTC-QLQ HN35) | 1 year post-treatment | QOL was measured by the European Organization for Research and Treatment for Cancer QOL Questionnaire for Head and Neck Cancer Module 35 (EORTC-QLQ HN35) at baseline and at 1-year post-treatment. Each question scores 0-4, with 0 being favorable and 4 being unfavorable. The average total score at baseline and average total score at 12 months post-RT is reported. The max total score possible is 140(Unfavorable) and the minimum total score possible is 0(Favorable). An increase in score indicates a greater quality of life A paired t-test compares the scores at these two timepoints. |
| EuroQol Five-dimensional Instrument (EQ-5D-3L) | 1 year post-treatment | QOL was measured by the three-level version of the EuroQol five-dimensional instrument (EQ-5D-3L) at baseline and 1-year post-treatment. This consisted of 5 questions, each score 0 to 3 points with 3 being unfavorable and 0 being favorable. The total possible score per patient per time point is 15 and a minimum score of 0(favorable). The change in average total score at baseline and 12 months post-RT is reported. A paired t-test compares the scores at these two time points. A higher score indicates greater impairment. |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORDaniel Ma
Mayo Clinic
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Cohort A (Intermediate Risk) Patients received 30 Gy delivered in 1.5-Gy fractions twice per day over 2 weeks along with 15 mg/m2 docetaxel once per week. | 36 |
| Cohort B (Extranodal Extension) Patients with extranodal extension who received the same treatment as Cohort A plus a simultaneous integrated boost to nodal levels with extranodal extension to 36 Gy in 1.8-Gy fractions twice per day. | 43 |
| Total | 79 |
Baseline characteristics
| Characteristic | Cohort B (Extranodal Extension) | Total | Cohort A (Intermediate Risk) |
|---|---|---|---|
| Age, Continuous | 58.9 years STANDARD_DEVIATION 10.2 | 58.7 years STANDARD_DEVIATION 8.8 | 58.4 years STANDARD_DEVIATION 6.7 |
| ECOG Performance Status 0 | 41 Participants | 75 Participants | 34 Participants |
| ECOG Performance Status 1 | 2 Participants | 4 Participants | 2 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 0 Participants | 0 Participants | 0 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 | 2 Participants | 2 Participants |
| Race (NIH/OMB) White | 43 Participants | 77 Participants | 34 Participants |
| Sex: Female, Male Female | 5 Participants | 8 Participants | 3 Participants |
| Sex: Female, Male Male | 38 Participants | 71 Participants | 33 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 38 | 1 / 43 |
| other Total, other adverse events | 38 / 38 | 43 / 43 |
| serious Total, serious adverse events | 5 / 38 | 5 / 43 |
Outcome results
Primary
2-year Loco-regional Tumor Control (LRC) Rate
The 2-year loco-regional tumor control (LRC) rate (percentage) is defined as the percentage of patients with no local/regional recurrence or death 2 years after study registration.
Time frame: 2 years
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Cohort A (Intermediate Risk) | 2-year Loco-regional Tumor Control (LRC) Rate | 100 percentage of patients |
| Cohort B (Extranodal Extension) | 2-year Loco-regional Tumor Control (LRC) Rate | 93 percentage of patients |
| Overall (Cohort A + Cohort B) | 2-year Loco-regional Tumor Control (LRC) Rate | 96.2 percentage of patients |
Secondary
2-year Distant Metastasis-free Survival Rate
The 2-year Distant metastasis-free survival rate (percentage) is defined as the percentage of patients with no distant recurrence or death 2 years after study registration.
Time frame: 2 years
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Cohort A (Intermediate Risk) | 2-year Distant Metastasis-free Survival Rate | 97.2 percentage of patients |
| Cohort B (Extranodal Extension) | 2-year Distant Metastasis-free Survival Rate | 88.4 percentage of patients |
Secondary
2-year Overall Survival (OS) Rate
The distribution of OS will be estimated using the method of Kaplan-Meier.
Time frame: 2 years
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Cohort A (Intermediate Risk) | 2-year Overall Survival (OS) Rate | 100 percentage of patients |
| Cohort B (Extranodal Extension) | 2-year Overall Survival (OS) Rate | 97.7 percentage of patients |
Secondary
2-year Progression-free Survival (PFS)
The distribution of PFS will be estimated using the method of Kaplan-Meier.
Time frame: From registration to the first of either disease recurrence or death, assessed up to 2 years
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Cohort A (Intermediate Risk) | 2-year Progression-free Survival (PFS) | 97.2 percentage of patients |
| Cohort B (Extranodal Extension) | 2-year Progression-free Survival (PFS) | 86.0 percentage of patients |
Secondary
Change From Mean Baseline Score to Mean Score at 12 Months Post-RT in Swallow Function as Measured by the Pharyngeal Total Modified Barium Swallow Impairment Profile.
The swallow evaluation consists of a modified barium swallow study(MBS), Functional Oral Intake Scale(FOIS), and Performance Status Scale Head & Neck(PSS-HN).The 17 swallow questions are rated using a 0 to 5 point scale, with 0 meaning no impairment and 5 max impairment. 6 questions produce a total oral score; scores from 10 questions produce a total pharyngeal score; 1 question produces an esophageal score.The PAS is a validated 8-point scale that ranks the depth of the bolus entry into the airway.A score of 1 indicates no airway entrance;score of 6+ indicate bolus passage past the vocal folds (aspiration).FOIS ranges from 1(nothing by mouth) to 7(total oral diet with no restrictions).PSS-H&N has 3 components:eating in public(0=always eat alone to 100=no restriction), understandability of speech(0=never understandable, score 100=always understandable), and normalcy of diet(score 0=tube fed to 100=full diet).These scores are summed and normalized to a 0 to 100 scale where 100 is best.
Time frame: 12 months
Population: All patients that completed a Swallow Function assessment at baseline and 12-month post-RT were included. The difference in dose (30 vs 36 Gy) was not expected to have any appreciable difference in toxicity or PRO. What they represented were two different risk groups, hence the need to publish separate cohort disease control metric and why it makes less sense to sort out risk groups for radiation toxicity. It was pre-specified to report this analysis to compare timepoints and not cohorts.
| Arm | Measure | Group | Value (MEAN) |
|---|---|---|---|
| Cohort A (Intermediate Risk) | Change From Mean Baseline Score to Mean Score at 12 Months Post-RT in Swallow Function as Measured by the Pharyngeal Total Modified Barium Swallow Impairment Profile. | Baseline time point | 5.57 score on a scale |
| Cohort A (Intermediate Risk) | Change From Mean Baseline Score to Mean Score at 12 Months Post-RT in Swallow Function as Measured by the Pharyngeal Total Modified Barium Swallow Impairment Profile. | 12 month time point | 4.48 score on a scale |
p-value: 0.01Paired t-test
Secondary
European Organization for Research and Treatment for Cancer QOL Questionnaire for Head and Neck Cancer Module 35 (EORTC-QLQ HN35)
QOL was measured by the European Organization for Research and Treatment for Cancer QOL Questionnaire for Head and Neck Cancer Module 35 (EORTC-QLQ HN35) at baseline and at 1-year post-treatment. Each question scores 0-4, with 0 being favorable and 4 being unfavorable. The average total score at baseline and average total score at 12 months post-RT is reported. The max total score possible is 140(Unfavorable) and the minimum total score possible is 0(Favorable). An increase in score indicates a greater quality of life A paired t-test compares the scores at these two timepoints.
Time frame: 1 year post-treatment
Population: All patients treated per protocol and completed the EORTC-QLQ HN35 forms were included in this analysis.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Cohort A (Intermediate Risk) | European Organization for Research and Treatment for Cancer QOL Questionnaire for Head and Neck Cancer Module 35 (EORTC-QLQ HN35) | 106.3 score on a scale | Standard Deviation 10.7 |
| Cohort B (Extranodal Extension) | European Organization for Research and Treatment for Cancer QOL Questionnaire for Head and Neck Cancer Module 35 (EORTC-QLQ HN35) | 111.4 score on a scale | Standard Deviation 9.2 |
p-value: <0.001Paired t-test
Secondary
EuroQol Five-dimensional Instrument (EQ-5D-3L)
QOL was measured by the three-level version of the EuroQol five-dimensional instrument (EQ-5D-3L) at baseline and 1-year post-treatment. This consisted of 5 questions, each score 0 to 3 points with 3 being unfavorable and 0 being favorable. The total possible score per patient per time point is 15 and a minimum score of 0(favorable). The change in average total score at baseline and 12 months post-RT is reported. A paired t-test compares the scores at these two time points. A higher score indicates greater impairment.
Time frame: 1 year post-treatment
Population: All patients who were treated per protocol and who completed a EQ-5D-3L were included in this analysis.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Cohort A (Intermediate Risk) | EuroQol Five-dimensional Instrument (EQ-5D-3L) | 6.3 score on a scale | Standard Deviation 1.3 |
| Cohort B (Extranodal Extension) | EuroQol Five-dimensional Instrument (EQ-5D-3L) | 5.5 score on a scale | Standard Deviation 0.9 |
p-value: <0.001Paired t-test
Secondary
Functional Assessment of Cancer Therapy Head and Neck (FACT H& N) (Version 4)
The FACT-H&N is a multidimensional, self-report QOL instrument specifically designed for use with head and neck cancer patients. It consists of 27 core items which assess patient function in four domains: Physical, Social/Family, Emotional, and Functional well-being, in addition to 12 site specific items to assess for head and neck related symptoms. Each item is rated on a 0 to 4 type scale where 4 is favorable and 0 unfavorable, and then combined to produce subscale scores for each domain, as well as a global QOL score- with possible score range from 0 to 156. Higher scores represent better QOL.
Time frame: 1 year
Population: All patients treated per protocol and completed the FACT H\&N forms were included in this analysis. The difference in dose (30 vs 36 Gy) was not expected to have any appreciable difference in toxicity or PRO. What they represented were two different risk groups, hence the need to publish separate cohort disease control metric and why it makes less sense to sort out risk groups for radiation toxicity. It was pre-specified to report this analysis to compare timepoints and not cohorts.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Cohort A (Intermediate Risk) | Functional Assessment of Cancer Therapy Head and Neck (FACT H& N) (Version 4) | Baseline | 117.2 score on a scale | Standard Deviation 17.7 |
| Cohort A (Intermediate Risk) | Functional Assessment of Cancer Therapy Head and Neck (FACT H& N) (Version 4) | 12 months | 127.2 score on a scale | Standard Deviation 17.7 |
p-value: <0.001Paired t-test
Secondary
Incidence of Grade 3 or Higher Mucositis Oral
The overall percentage of patients experiencing grade 3 or higher mucositis oral graded according to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 are reported below.
Time frame: 4 months post-hyperfractionated radiation therapy
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Cohort A (Intermediate Risk) | Incidence of Grade 3 or Higher Mucositis Oral | 8.3 percentage of patients |
| Cohort B (Extranodal Extension) | Incidence of Grade 3 or Higher Mucositis Oral | 4.7 percentage of patients |
Other Pre-specified
Changes in Transforming Growth Factor (TGF)-beta1 Levels
These markers will be correlated with clinical endpoints like acute adverse events, cumulative incidence rates of local/regional failure, overall survival, and disease-free survival.
Time frame: Baseline to 1 week post-radiation
Other Pre-specified
E6/E7 Messenger Ribonucleic Acid (mRNA) of HPV16, Assessed on a Chromogenic RNA in Situ Hybridization (ISH) Assay Called RNAscope
These markers will be correlated with clinical endpoints like acute adverse events, cumulative incidence rates of local/regional failure, overall survival, and disease-free survival.
Time frame: Baseline