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For advanced head and neck cancer, combined radiation and chemotherapy prevents recurrences and for many patients, improves survival. While combined cisplatin and radiation or cetuximab and radiation is more effective than radiation alone, approximately 50% of these patients will still recur. A more aggressive approach may be needed for these patients to prevent recurrence and death. The strategy of using multiple chemotherapy drugs with radiation given twice a day has been tested at Mount Sinai and University of Chicago. Approximately 80% of patients are cured with this strategy. While cure rates are higher than standard chemotherapy and radiation and the treatment is tolerable, side effects during treatment are common. We propose replacing a chemotherapy drug with a less toxic, targeted therapy called cetuximab. Our goal is to reduce toxicity while maintaining or improving cure rates for these patients.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Advanced Head and Neck Cancer | Experimental | Patients with stage IVA and IVB or high-risk stage III squamous cell carcinomas of the head and neck |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Cetuximab | Drug | 250 mg/m2 on Day 1 after the first dose of radiation was administered to all patients |
|
| Measure | Description | Time Frame |
|---|---|---|
| Llocoregional Recurrence | Percentage of Participants with Loco-regional recurrence. | 2 years |
| Survival | Overall Survival - Percentage of Participants who survived Disease-Free Survival - measured from the initiation of nonsurgical treatment to either the last follow-up, disease progression, or death using intent-to-treat methodology | 2 years |
| Measure | Description | Time Frame |
|---|---|---|
| Long- Term Toxicity | Grade 3 toxicities events | 2 years |
| UW-QOLR: Quality of Life Score | University of Washington Quality of Life (UW-QOLR) questionnaire - covers 12 domains - pain, appearance, activity, recreation, swallowing, chewing, speech, shoulder function, taste, saliva, mood and anxiety. Each domain have between 3 and 6 response options that are scaled evenly from 0 (worst) to 100 (best) according to the hierarchy of response and reported as one composite score from 0 (worst) to 100 (best). |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Johnny Kao, MD | Icahn School of Medicine at Mount Sinai | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Mount Sinai School of Medicine | New York | New York | 10029 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 20830768 | Result | Kao J, Genden EM, Gupta V, Policarpio EL, Burri RJ, Rivera M, Gurudutt V, Som PM, Teng M, Packer SH. Phase 2 trial of concurrent 5-fluorouracil, hydroxyurea, cetuximab, and hyperfractionated intensity-modulated radiation therapy for locally advanced head and neck cancer. Cancer. 2011 Jan 15;117(2):318-26. doi: 10.1002/cncr.25374. Epub 2010 Sep 9. |
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Recruitment period January 2007 through April 2008. All cases were reviewed at a multidisciplinary conference, which was attended by representatives from the Departments of Head and Neck Surgery, Radiation Oncology, Medical Oncology, Palliative Care, Social Work, and Nutrition at Icahn School of Medicine at Mount Sinai.
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| ID | Title | Description |
|---|---|---|
| FG000 | Advanced Head and Neck Cancer | Patients with stage IVA and IVB or high-risk stage III squamous cell carcinomas of the head and neck. Cetuximab- 250 mg/m2 on Day 1 after the first dose of radiation was administered to all patients. Hydroxyurea - 500 mg orally every 12 hours with the morning dose administered 2 hours before radiation. Fluorouracil - continuous-infusion 5-FU at a dose of 600 mg/m2 daily for 120 hours. Radiotherapy. Radiotherapy was administered at 1.5 Gy per fraction twice daily with treatments separated by at least 6 hours on Days 1 through 5 on an alternating week schedule. Radiation was delivered with intensity-modulated radiation therapy (IMRT) planning for all patients. |
| Title | Milestones | Reasons Not Completed | |||||
|---|---|---|---|---|---|---|---|
| Overall Study |
|
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| Hydroxyurea | Drug | 500 mg orally every 12 hours with the morning dose administered 2 hours before radiation |
|
| Fluorouracil | Drug | continuous-infusion 5-FU at a dose of 600 mg/m2 daily for 120 hours |
|
| radiotherapy | Procedure | Radiotherapy was administered at 1.5 Gy per fraction twice daily with treatments separated by at least 6 hours on Days 1 through 5 on an alternating week schedule. Radiation was delivered with intensity-modulated radiation therapy (IMRT) planning for all patients. |
|
| 2 years |
| Distant Metastases | Percentage of participants who did not have distant control | 2 years |
| COMPLETED |
|
| NOT COMPLETED |
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| ID | Title | Description |
|---|---|---|
| BG000 | Advanced Head and Neck Cancer | Cetuximab- 250 mg/m2 on Day 1 after the first dose of radiation was administered to all patients. Hydroxyurea - 500 mg orally every 12 hours with the morning dose administered 2 hours before radiation. Fluorouracil - continuous-infusion 5-FU at a dose of 600 mg/m2 daily for 120 hours. Radiotherapy. |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Median | Full Range | years |
| ||||||||||||||||||||||
| Sex: Female, Male | Count of Participants | Participants |
| |||||||||||||||||||||||
| Race/Ethnicity, Customized | Number | participants |
| |||||||||||||||||||||||
| Performance score | The Eastern Cooperative Oncology Group (ECOG) 0 - Fully active, able to carry on all pre-disease performance without restriction 1 - Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature 2- Ambulatory and capable of all selfcare but unable to carry out any work activities; up and about more than 50% of waking hours | Number | participants |
| ||||||||||||||||||||||
| Charlson comorbidity score | The Charlson Comorbidity Index contains 19 categories of comorbidity and predicts the ten-year mortality for a patient who may have a range of co-morbid conditions. Each condition is assigned a score of 1, 2, 3, or 6, depending on the risk of dying associated with each one. Scores are summed to provide a total score to predict mortality. Higher scores indicating greater comorbidity (patients with a score > 5 have essentially a 100% risk of dying at one year). | Number | participants |
| ||||||||||||||||||||||
| Alcohol consumption | Number | participants |
| |||||||||||||||||||||||
| Smoking | Number | participants |
| |||||||||||||||||||||||
| Primary site | Number | participants |
|
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | ||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Llocoregional Recurrence | Percentage of Participants with Loco-regional recurrence. | Posted | Count of Participants | Participants | 2 years |
|
|
| |||||||||||||||||||||||||||
| Primary | Survival | Overall Survival - Percentage of Participants who survived Disease-Free Survival - measured from the initiation of nonsurgical treatment to either the last follow-up, disease progression, or death using intent-to-treat methodology | Posted | Number | percentage of participants | 2 years |
|
| ||||||||||||||||||||||||||||
| Secondary | Long- Term Toxicity | Grade 3 toxicities events | Posted | Number | events | 2 years |
|
| ||||||||||||||||||||||||||||
| Secondary | UW-QOLR: Quality of Life Score | University of Washington Quality of Life (UW-QOLR) questionnaire - covers 12 domains - pain, appearance, activity, recreation, swallowing, chewing, speech, shoulder function, taste, saliva, mood and anxiety. Each domain have between 3 and 6 response options that are scaled evenly from 0 (worst) to 100 (best) according to the hierarchy of response and reported as one composite score from 0 (worst) to 100 (best). | Twenty patients completed the UW-QOLR questionnaire before and after therapy. | Posted | Mean | Full Range | units on a scale | 2 years |
|
| ||||||||||||||||||||||||||
| Secondary | Distant Metastases | Percentage of participants who did not have distant control | Posted | Number | percentage of participants | 2 years |
|
|
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Advanced Head and Neck Cancer | Patients with stage IVA and IVB or high-risk stage III squamous cell carcinomas of the head and neck | 33 | 33 | 33 | 33 |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Mucositis | Gastrointestinal disorders | NCI CTCAE 3.0 | Systematic Assessment |
| |
| Dermatitis | Skin and subcutaneous tissue disorders | NCI CTCAE 3.0 | Systematic Assessment |
| |
| Pain | General disorders | NCI CTCAE 3.0 | Systematic Assessment |
| |
| Low Absolute neutrophil count | Blood and lymphatic system disorders | NCI CTCAE 3.0 | Systematic Assessment |
| |
| Low White blood count | Blood and lymphatic system disorders | NCI CTCAE 3.0 | Systematic Assessment |
| |
| Low Hemoglobin count | Blood and lymphatic system disorders | NCI CTCAE 3.0 | Systematic Assessment |
| |
| Low Platelets count | Blood and lymphatic system disorders | NCI CTCAE 3.0 | Systematic Assessment |
|
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Mucositis | Gastrointestinal disorders | NCI CTCAE 3.0 | Systematic Assessment |
| |
| Dermatitis | Skin and subcutaneous tissue disorders | NCI CTCAE 3.0 | Systematic Assessment |
| |
| Pain | General disorders | NCI CTCAE 3.0 | Systematic Assessment |
| |
| Xerostomia | General disorders | NCI CTCAE 3.0 | Systematic Assessment |
| |
| Low Absolute neutrophil count | Blood and lymphatic system disorders | NCI CTCAE 3.0 | Systematic Assessment |
| |
| Low White blood count | Blood and lymphatic system disorders | NCI CTCAE 3.0 | Systematic Assessment |
| |
| Low Hemoglobin count | Blood and lymphatic system disorders | NCI CTCAE 3.0 | Systematic Assessment |
| |
| Low Platelet count | Blood and lymphatic system disorders | NCI CTCAE 3.0 | Systematic Assessment |
|
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. Johnny Kao | Florida Radiation Oncology Group | 813-661-6442 | johnnykaomd@gmail.com |
| ID | Term |
|---|---|
| D006258 | Head and Neck Neoplasms |
| D010610 | Pharyngeal Neoplasms |
| D007822 | Laryngeal Neoplasms |
| D009669 | Nose Neoplasms |
| D010255 | Paranasal Sinus Neoplasms |
| ID | Term |
|---|---|
| D009371 | Neoplasms by Site |
| D009369 | Neoplasms |
| D010039 | Otorhinolaryngologic Neoplasms |
| D010608 | Pharyngeal Diseases |
| D009057 | Stomatognathic Diseases |
| D010038 | Otorhinolaryngologic Diseases |
| D007818 | Laryngeal Diseases |
| D012140 | Respiratory Tract Diseases |
| D012142 | Respiratory Tract Neoplasms |
| D012888 | Skull Neoplasms |
| D001859 | Bone Neoplasms |
| D001847 | Bone Diseases |
| D009140 | Musculoskeletal Diseases |
| D009668 | Nose Diseases |
| D010254 | Paranasal Sinus Diseases |
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| ID | Term |
|---|---|
| D000068818 | Cetuximab |
| D006918 | Hydroxyurea |
| D005472 | Fluorouracil |
| D011878 | Radiotherapy |
| ID | Term |
|---|---|
| D061067 | Antibodies, Monoclonal, Humanized |
| D000911 | Antibodies, Monoclonal |
| D000906 | Antibodies |
| D007136 | Immunoglobulins |
| D007162 | Immunoproteins |
| D001798 | Blood Proteins |
| D011506 | Proteins |
| D000602 | Amino Acids, Peptides, and Proteins |
| D012712 | Serum Globulins |
| D005916 | Globulins |
| D014508 | Urea |
| D000577 | Amides |
| D009930 | Organic Chemicals |
| D014498 | Uracil |
| D011744 | Pyrimidinones |
| D011743 | Pyrimidines |
| D006573 | Heterocyclic Compounds, 1-Ring |
| D006571 | Heterocyclic Compounds |
| D013812 | Therapeutics |
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| Hispanic |
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| Asian |
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| 2 |
|
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| Moderate |
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| Heavy |
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| ≤20 pack-y |
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| 20.1-40 packk-y |
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| >40 pack-y |
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| Oropharynx |
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| Oral cavity |
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| Salivary gland |
|
| Larynx |
|
| Hyopharynx |
|
| Unknown primary |
|
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| Title | Denominators | Categories |
|---|
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| Title | Denominators | Categories | ||||
|---|---|---|---|---|---|---|
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