Gene Therapy in Preventing Cancer in Patients With Premalignant Carcinoma of the Oral Cavity or Pharynx
Lip and Oral Cavity Cancer, Oropharyngeal Cancer, Stage 0 Lip and Oral Cavity Cancer
About this trial
This is an interventional prevention trial for Lip and Oral Cavity Cancer
Eligibility Criteria
Inclusion Criteria: Histologically confirmed mild to moderate dysplasia OR severe dysplasia/carcinoma in situ of the oral cavity or oral pharynx Clinically evident diffuse premalignant disease, defined by 1 of the following mucosal abnormalities: Extension between adjacent organ structures (e.g., lateral tongue, ventral tongue, and the floor of the mouth) Extensive surface area, including the entire ventral tongue or floor of the mouth or buccal mucosa, in a velvety "indiscreet" pattern Meets 1 of the following criteria: Previously treated with conventional treatment (e.g., radiotherapy or surgery) for a prior head and neck malignancy Failed biochemoprevention approaches for premalignant disease Failed other therapeutic approaches for premalignant disease No active squamous cell carcinoma of the head and neck Performance status - Karnofsky 70-100% Absolute granulocyte count at least 2,000/mm^3 Platelet count at least 100,000/mm^3 Bilirubin no greater than 1.0 mg/dL Creatinine no greater than 1.5 mg/dL No hypertension (baseline blood pressure 140/90 mm Hg or higher) Not pregnant or nursing Negative pregnancy test Fertile patients must use effective barrier contraception during and for 1 year after study participation HIV-1 negative No known contact with former tissue or organ transplantation recipients or individuals with severe immunodeficiency disease (acquired or congenital) during and for 28 days after study treatment No prior malignancy within the past 2 years except nonmelanoma skin cancer or aerodigestive cancer No active systemic viral, bacterial, or fungal infections requiring treatment No serious concurrent illness that would preclude study compliance and follow-up No psychological, familial, sociological, geographical, or other condition that would preclude study compliance and follow-up See Disease Characteristics More than 21 days since prior chemotherapy (42 days for mitomycin and nitrosoureas) No concurrent systemic chemotherapy No concurrent prednisone or the equivalent, including corticosteroids of more than 10 mg/day See Disease Characteristics More than 3 months since prior radiotherapy involving the lesion selected for this study No concurrent radiotherapy See Disease Characteristics More than 8 weeks since prior investigational agents No prior experimental therapy (i.e., oral, systemic, topical, or direct injection) for the lesion selected for treatment in this study No other concurrent immunosuppressive therapy No other concurrent investigational agents No concurrent aspirin dose greater than 175 mg/day
Sites / Locations
- M D Anderson Cancer Center
Arms of the Study
Arm 1
Experimental
Treatment (Ad5CMV-p53 gene)
Phase I: Patients receive Ad5CMV-p53 gene by intramucosal injection into the area of the lesion followed at least 2 hours later by Ad5CMV-p53 gene as an oral rinse on day 1. Patients then receive Ad5CMV-p53 gene as an oral rinse twice daily on days 2-5. Treatment repeats every 28 days for 6 courses in the absence of disease progression or unacceptable toxicity. Cohorts of 3-6 patients receive escalating doses of Ad5CMV-p53 gene as an oral rinse until the MTD is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity. Phase II: Patients receive treatment with intramucosal Ad5CMV-p53 gene as in phase I and Ad5CMV-p53 gene as an oral rinse at the MTD.