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Evaluation of De-escalated Adjuvant Radiation Therapy for Human Papillomavirus (HPV)-Associated Oropharynx Cancer

Primary Purpose

Oropharynx Cancer

Status
Active
Phase
Phase 3
Locations
United States
Study Type
Interventional
Intervention
Adjuvant Radiation Therapy
Docetaxel
Cisplatin
Sponsored by
Mayo Clinic
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Oropharynx Cancer

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Age ≥ 18 years.
  • 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.
  • ECOG Performance Status (PS) 0 or 1
  • Absence of distant metastases on standard diagnostic work-up ≤ 10 weeks prior to registration. (Chest CT, Chest x-ray (CXR), or PET/CT.)
  • 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 T4 primary disease
    • Lymph node extracapsular extension
  • The following laboratory values obtained ≥14 days prior to registration.

    • Absolute neutrophil count (ANC) ≥1500/mm3
    • Platelet count ≥100,000/mm3
    • Hemoglobin ≥8.0g/dL
    • Creatinine ≤ 1.5 mg/dL or creatinine clearance ≥ 50 mL/min
    • Total bilirubin < 2 x institutional upper limit of normal (ULN)
    • AST or ALT < 3 x institutional ULN
  • 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 of the following because this study involves an agent that has known genotoxic, mutagenic and teratogenic effects:

    • 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 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.
  • 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.
  • Receiving any medications or substances which in the opinion of the investigators would interfere with treatment. Examples could include strong inhibitors of CYP3A4 at oncologist discretion (see Appendix IV).
  • Severe pre-existing ototoxicity or neuropathy that would, in the opinion of the investigator, preclude the use of cisplatin chemotherapy.

Sites / Locations

  • Mayo Clinic in Arizona
  • Mayo Clinic in Rochester

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

De-escalated Adjuvant Radiation Therapy

Standard of Care Treatment

Arm Description

Docetaxel 15 mg/m2 days 1, 8 + Radiation Therapy (RT) 30 Gy/1.5 Gy fractions twice daily (b.i.d.) days 1-12 only (intermediate risk) or 36 Gy/1.8 Gy b.i.d. fractions (high risk)

RT 60 Gy/2 Gy fractions daily (qday) days 1-40. For high risk, add weekly Cisplatin 40 mg/m2 (Around days 1, 8, 15, 22, 29, 36)

Outcomes

Primary Outcome Measures

Adverse Events Rate
To compare rate of late grade 3-5 toxicities between de-escalated adjuvant radiation therapy (DART) and standard adjuvant therapy.

Secondary Outcome Measures

Local/regional control
Local/regional failure as assessed by imaging or physical exam at 2 years after study registration for patients treated with DART vs standard therapy.
Quality of Life between DART and standard adjuvant therapy
To compare the overall QOL between DART and standard adjuvant therapy at 1-year post-treatment as measured by FACT H&N questionnaire.
Quality of Life between DART and standard adjuvant therapy
To compare the overall QOL between DART and standard adjuvant therapy at 1-year post-treatment as measured by the EORTC H&N quality of life questionnaire (QLQ) 35.
Overall Survival
Disease-free survival
Distant failure associated with DART vs standard treatment

Full Information

First Posted
August 26, 2016
Last Updated
August 10, 2023
Sponsor
Mayo Clinic
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1. Study Identification

Unique Protocol Identification Number
NCT02908477
Brief Title
Evaluation of De-escalated Adjuvant Radiation Therapy for Human Papillomavirus (HPV)-Associated Oropharynx Cancer
Official Title
DART-HPV: A Phase III Evaluation of De-escalated Adjuvant Radiation Therapy for HPV-Associated Oropharynx Cancer
Study Type
Interventional

2. Study Status

Record Verification Date
August 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
October 3, 2016 (Actual)
Primary Completion Date
August 20, 2022 (Actual)
Study Completion Date
September 15, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Mayo Clinic

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This study is designed for patients with a cancer of the oropharynx (tonsils or base of tongue) caused by the HPV virus. Traditional treatment involves surgery followed by six weeks of daily radiation therapy. This study investigates a less intense radiation treatment following surgery that uses half the dose of radiation given over two weeks rather than six weeks. Patients will be randomly assigned to receive the less intense treatment versus the traditional treatment by coin flip. Patients are twice as likely to receive the less intense treatment during randomization.
Detailed Description
Recent studies suggest that tumors in the oropharynx (tonsils or base of tongue) caused by the HPV virus are much more sensitive to radiation and chemotherapy. Standard treatment for HPV associated oropharynx tumor after surgery involves six weeks of radiation therapy and has many long term side effects and complications. Mayo Clinic recently piloted a study investigating whether patients with HPV-associated oropharynx tumors can receive less radiation and chemotherapy after surgery when compared with the standard treatment. The investigators current study will compare the new, shorter treatment course (2 weeks of treatment) with the standard course of treatment (six weeks). Patients will be randomized to either the less intense or standard treatment arm. Patients will be twice as likely to receive the less intense treatment during randomization.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Oropharynx Cancer

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
227 (Actual)

8. Arms, Groups, and Interventions

Arm Title
De-escalated Adjuvant Radiation Therapy
Arm Type
Experimental
Arm Description
Docetaxel 15 mg/m2 days 1, 8 + Radiation Therapy (RT) 30 Gy/1.5 Gy fractions twice daily (b.i.d.) days 1-12 only (intermediate risk) or 36 Gy/1.8 Gy b.i.d. fractions (high risk)
Arm Title
Standard of Care Treatment
Arm Type
Active Comparator
Arm Description
RT 60 Gy/2 Gy fractions daily (qday) days 1-40. For high risk, add weekly Cisplatin 40 mg/m2 (Around days 1, 8, 15, 22, 29, 36)
Intervention Type
Radiation
Intervention Name(s)
Adjuvant Radiation Therapy
Intervention Description
60 Gy / 2 Gy fractions (standard arm) 30 - 36 Gy / 1.5 - 1.8 Gy b.i.d. fractions (experimental arm)
Intervention Type
Drug
Intervention Name(s)
Docetaxel
Other Intervention Name(s)
Taxotere
Intervention Description
15 mg/m2. Experimental arm only.
Intervention Type
Drug
Intervention Name(s)
Cisplatin
Other Intervention Name(s)
cisplatinum
Intervention Description
40 mg/m2. Standard arm only.
Primary Outcome Measure Information:
Title
Adverse Events Rate
Description
To compare rate of late grade 3-5 toxicities between de-escalated adjuvant radiation therapy (DART) and standard adjuvant therapy.
Time Frame
2 years
Secondary Outcome Measure Information:
Title
Local/regional control
Description
Local/regional failure as assessed by imaging or physical exam at 2 years after study registration for patients treated with DART vs standard therapy.
Time Frame
2 years
Title
Quality of Life between DART and standard adjuvant therapy
Description
To compare the overall QOL between DART and standard adjuvant therapy at 1-year post-treatment as measured by FACT H&N questionnaire.
Time Frame
1 year
Title
Quality of Life between DART and standard adjuvant therapy
Description
To compare the overall QOL between DART and standard adjuvant therapy at 1-year post-treatment as measured by the EORTC H&N quality of life questionnaire (QLQ) 35.
Time Frame
1 year
Title
Overall Survival
Time Frame
2 years
Title
Disease-free survival
Time Frame
2 years
Title
Distant failure associated with DART vs standard treatment
Time Frame
2 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Age ≥ 18 years. 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. ECOG Performance Status (PS) 0 or 1 Absence of distant metastases on standard diagnostic work-up ≤ 10 weeks prior to registration. (Chest CT, Chest x-ray (CXR), or PET/CT.) 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 T4 primary disease Lymph node extracapsular extension The following laboratory values obtained ≥14 days prior to registration. Absolute neutrophil count (ANC) ≥1500/mm3 Platelet count ≥100,000/mm3 Hemoglobin ≥8.0g/dL Creatinine ≤ 1.5 mg/dL or creatinine clearance ≥ 50 mL/min Total bilirubin < 2 x institutional upper limit of normal (ULN) AST or ALT < 3 x institutional ULN 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 of the following because this study involves an agent that has known genotoxic, mutagenic and teratogenic effects: 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 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. 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. Receiving any medications or substances which in the opinion of the investigators would interfere with treatment. Examples could include strong inhibitors of CYP3A4 at oncologist discretion (see Appendix IV). Severe pre-existing ototoxicity or neuropathy that would, in the opinion of the investigator, preclude the use of cisplatin chemotherapy.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Daniel Ma, M.D.
Organizational Affiliation
Mayo Clinic
Official's Role
Principal Investigator
Facility Information:
Facility Name
Mayo Clinic in Arizona
City
Scottsdale
State/Province
Arizona
ZIP/Postal Code
85259
Country
United States
Facility Name
Mayo Clinic in Rochester
City
Rochester
State/Province
Minnesota
ZIP/Postal Code
55905
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

Evaluation of De-escalated Adjuvant Radiation Therapy for Human Papillomavirus (HPV)-Associated Oropharynx Cancer

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