De-Escalation Protocol Of HPV Mediated Oropharyngeal Squamous Cell Carcinoma

Oropharynx Cancer Clinical Trial

Official title:

De-Escalation Protocol Of HPV Mediated Oropharyngeal Squamous Cell Carcinoma Based On The AJCC 8th Edition Staging Manual

Clinical Trial Details — Status: Active, not recruiting

Administrative data

• NCT number: NCT04638465
• Other study ID #: MECC-HN01
• Status: Active, not recruiting
• Start date: August 6, 2018
• Est. completion date: January 2030

Study information

• Verified date: April 2023
• Source: Nebraska Methodist Health System
• Contact: n/a
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

The purpose of this study is to evaluate the effects, good and/or bad, of treating participants with HPV-mediated oropharyngeal cancer, with less treatment, using the new staging system. The investigators believe this treatment will provide the same effectiveness as the usual treatment, but decrease the side effects. The radiation doses, chemotherapy doses, and the type of surgical approaches that will be used in this treatment protocol have all been previously investigated. Previous research suggests that this can be done safely, but there has not been a study done basing treatment on the new staging system.

Recruitment information / eligibility

• Status: Active, not recruiting
• Enrollment: 150
• Est. completion date: January 2030
• Est. primary completion date: January 2025
• Accepts healthy volunteers: No
• Gender: All
• Age group: 19 Years and older

Eligibility

Inclusion Criteria:

• Participants must have newly diagnosed, histologically, or cytologically confirmed HPV positive, squamous cell carcinoma of the base of tongue, tonsil, oropharyngeal cavity or unknown primary.

• Participants must have tumors staged using AJCC TNM 8th edition Staging for Head and Neck cancers.

• Participants must have an exam by a Head and Neck Oncologist within 6 weeks before registration.

• Participants must not have any evidence of distant metastatic disease.

• Participants with other active malignancies may be eligible, at the discretion of the investigator, as long as the treatment plan for the head and neck cancer outlined in this protocol can still be followed. The potential effect of the treatment and disease progress of the second active malignancy should also have minimal or no impact on the toxicities being monitored on this study.

• Participants must not have any uncontrolled intercurrent illnesses, psychiatric illnesses, psychosocial problems, or social situations that would limit the patient's compliance with the study or ability to successfully complete the study treatment safely.

• Participants with inconclusive pathology after biopsy; who are found to have HPV positive SCC following standard of care surgery are eligible to enroll.

• Participants who require additional surgery to complete staging with known HPV+ SCC are eligible to enroll.

Exclusion Criteria:

• Participants must not be receiving or planning to receive any other clinical trial therapy or intervention.

• Participants with an unknown primary tumor who are both HPV positive and EBV positive are NOT eligible for this protocol.

These additional evaluations must be performed on participants with T0 (unknown primary site) P16+ squamous cell carcinoma of the head and neck prior to registration.

• Flexible laryngoscope

• Ultrasound guided Fine-needle aspirate (FNA) of the known site of disease with the following analysis:

• Human papilloma virus (HPV); p16 Immuno-Histo-Chemical Staining. If negative, complete high risk HPV Fluorescence in-situ Hybridization (FISH).

• Epstein Barr Virus (EBV): Epstein Barr Virus Encoded RNA (EBER) in-situ Hybridization.

• Direct Laryngoscopy with directed biopsy of bilateral base of tongue, bilateral palatine tonsillectomy, and dental extraction, as needed.

If a participant is both HPV positive and EBV positive, he/she is not eligible.

Related Conditions & MeSH terms

• Carcinoma
• Carcinoma, Squamous Cell
• HPV-Mediated (P16-Positive) Oropharyngeal Carcinoma by AJCC V8 Clinical Stage
• Oropharyngeal Neoplasms
• Oropharynx Cancer
• Squamous Cell Carcinoma of Head and Neck

Intervention

Procedure:
• Transoral robotic surgery
Transoral resection with neck dissection

Drug:
• Cisplatin - Dose Level 1
6 Cycles of 40 mg/m2
• Cisplatin - Dose Level 2
7 Cycles of 40 mg/m2

Radiation:
• Dose Level 1
60 Gy/6 weeks - 2 Gy/fraction, 5 fractions/week
• Dose Level 2
70 Gy/7 weeks - 2 Gy/fraction, 5 fractions/week

Locations

Country	Name	City	State
United States	Nebraska Methodist Hospital	Omaha	Nebraska

Sponsors (1)

Lead Sponsor	Collaborator
Nebraska Methodist Health System

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Overall survival	To determine if overall survival remains the same with the de-escalated protocol as the historical standard of care survival benefit.	From randomization to death, assessed up to 10 years
Primary	Disease Free Survival	To determine if disease free survival remains the same with the de-escalated protocol as the historical standard of care survival benefit.	From randomization to date of progression, second primary tumor from the head and neck region, or death, assessed up to 10 years
Secondary	Rate of Patients with a Grade 3 or Higher Adverse Event	To evaluate the side effects patients experience when being treated on the de-escalated protocol.	From randomization to death, assessed up to 10 years
Secondary	Measure the quality of life of participants using the FACT H&N assessment tool	To evaluate the quality of life of patients who are treated with the de-escalated protocol.	From randomization to death, assessed up to 10 years
Secondary	Measure the depression of participants using the Self-Report Quick Inventory of Depressive Symptomatology assessment	To evaluate depression in patients who are treated with the de-escalated protocol.	From randomization to death, assessed up to 10 years