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Phase III Randomized Study of Radiotherapy With or Without Epoetin alfa in Anemic Patients With Squamous Cell Carcinoma of the Head and Neck
Alternate Title Basic Trial Information Objectives Entry Criteria Expected Enrollment Outline Published Results Trial Contact Information Registry Information
Alternate Title
Radiation Therapy With or Without Epoetin alfa in Treating Anemic Patients With
Head and Neck Cancer
Basic Trial Information
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Phase
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Type
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Status
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Age
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Sponsor
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Protocol IDs
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Phase III
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Supportive care, Treatment
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Completed
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18 and over
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NCI
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RTOG-9903 RTOG-DEV-1008, NCT00004917, RTOG-99-03
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Objectives Primary - Determine whether epoetin alfa given during definitive radiotherapy or chemoradiotherapy improves the local-regional control rate in anemic patients with squamous cell carcinoma of the head and neck.
Secondary - Determine whether this drug improves survival in this patient population.
- Identify patterns in first failure in these patients.
- Determine whether there is a significant increase in hemoglobin level between the baseline value and the value at 28 days after starting epoetin alfa in these patients.
- Assess the toxicity of this regimen in these patients.
Entry Criteria Disease Characteristics:
- Histologically confirmed invasive squamous cell carcinoma of the head and
neck, including carcinoma arising from the oral cavity, oropharynx,
larynx,
and hypopharynx
- Stage I-IV disease
- No distant metastases
- No carcinoma of the nasopharynx, nasal
cavity/paranasal sinuses, or salivary
glands
- No carcinoma in situ without an identifiable invasive
component
- Plan for radiotherapy in continuous course
- Prior surgical exploration with gross residual disease remaining allowed
- Prior neck dissection with or without biopsy of primary tumor, but no
radical surgery for primary tumor, allowed
- Anemia, defined as hemoglobin no greater than 13.5 g/dL for males and no
greater than 12.5 g/dL for females (transfusion prior to study allowed)
- No severe anemia (i.e., hemoglobin less than 9.0 g/dL)
- No anemia confirmed to be due to causes other than
chronic disease (e.g.,
iron deficiency anemia)
- Not entered on other RTOG head and neck protocols
Prior/Concurrent Therapy:
Biologic therapy: - At least 4 weeks since other prior cytokine therapy (e.g.,
filgrastim [G-CSF], interleukins, or interferons)
- No prior epoetin alfa
- No other concurrent cytokine therapy
Chemotherapy: - No prior chemotherapy
- Concurrent cisplatin, paclitaxel/cisplatin, or paclitaxel/carboplatin for patients with stage III/IV disease is
allowed
Endocrine therapy: Radiotherapy: - See Disease Characteristics
- No prior radiotherapy to the head and neck
Surgery: - See Disease Characteristics
Other: - No concurrent amifostine
- No concurrent transfusion
Patient Characteristics:
Age: Performance status: Life expectancy: Hematopoietic: - See Disease Characteristics
- Stage III/IV patients receiving concurrent
cisplatin:
- Absolute neutrophil count at least 2,000/mm3
- Platelet count at least 100,000/mm3
Hepatic: Renal: - Stage III/IV patients receiving concurrent
cisplatin:
- Creatinine no greater than 1.5 mg/dL
- Creatinine clearance at least 50 mL/min
Cardiovascular: - No malignant or poorly controlled hypertension (e.g., symptomatic hypertension or diastolic blood pressure of 100
mm Hg or greater despite antihypertensive medication)
- No unstable angina or other poorly controlled cardiac
disease
Other: - Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception
- If stage III or IV disease is present, willing to come for twice
daily radiotherapy for the last 2.5 weeks of therapy
- No active infection requiring IV antibiotics
- No unexplained fever
- No AIDS or other history of congenital or acquired
immunodeficiency
- No other malignancies within the past 3 years except carcinoma
in situ or nonmelanomatous skin cancer
- No known hypersensitivity to mammalian cell-derived products
or to human albumin
- No acute/subacute illness that would make the need for transfusion
likely
Expected Enrollment A total of 372 patients (186 per arm) will be accrued for this study within
3.5 years. Outline This is a randomized study. Patients are stratified according to stage
(I/II vs III/IV without chemotherapy vs III/IV with chemotherapy),
pretreatment hemoglobin level (9.0 to less than 11.5 g/dL vs 11.5 to 13.5
g/dL), and gender. Patients are randomized to one of two treatment arms. - Arm I: Patients with stage I or II disease undergo radiotherapy once
daily for 6-7 weeks. Patients with stage III or IV disease undergo
radiotherapy once daily for 3.5 weeks and then twice daily (6 hours apart)
for 2.5 weeks for a total of 6 weeks.
- Arm II: Patients undergo radiotherapy as in arm I. Beginning 7-10 days
before radiotherapy, patients receive epoetin alfa subcutaneously once weekly
until the end of radiotherapy.
Patients with stage III/IV disease may receive concurrent cisplatin IV
over 1-2 hours on days 1 and 22 of radiotherapy. Patients are followed every 3 months for 2 years, every 6
months for 3 years, and then annually thereafter. Published ResultsMachtay M, Pajak TF, Suntharalingam M, et al.: Radiotherapy with or without erythropoietin for anemic patients with head and neck cancer: a randomized trial of the Radiation Therapy Oncology Group (RTOG 99-03). Int J Radiat Oncol Biol Phys 69 (4): 1008-17, 2007.[PUBMED Abstract] Machtay M, Pajak T, Suntharalingam M, et al.: Definitive radiotherapy +/- erythropoietin for squamous cell carcinoma of the head and neck: preliminary report of RTOG 99-03. [Abstract] Int J Radiat Oncol Biol Phys 60 (Suppl 1): A-5, S132, 2004.
Trial Contact Information
Trial Lead Organizations Radiation Therapy Oncology Group ![](https://webarchive.library.unt.edu/eot2008/20081012034354im_/http://www.cancer.gov/images/spacer.gif) | ![](https://webarchive.library.unt.edu/eot2008/20081012034354im_/http://www.cancer.gov/images/spacer.gif) | ![](https://webarchive.library.unt.edu/eot2008/20081012034354im_/http://www.cancer.gov/images/spacer.gif) | Mitchell Machtay, MD, Protocol chair(Contact information may not be current) | ![](https://webarchive.library.unt.edu/eot2008/20081012034354im_/http://www.cancer.gov/images/spacer.gif) | | ![](https://webarchive.library.unt.edu/eot2008/20081012034354im_/http://www.cancer.gov/images/spacer.gif) |
Registry Information | ![](https://webarchive.library.unt.edu/eot2008/20081012034354im_/http://www.cancer.gov/images/spacer.gif) | Official Title | | A Randomized Phase III Trial to Assess the Effect of Erythropoietin on Local-Regional Control in Anemic Patients Treated with Radiotherapy for Carcinoma of the Head and Neck | ![](https://webarchive.library.unt.edu/eot2008/20081012034354im_/http://www.cancer.gov/images/spacer.gif) | Trial Start Date | | 2000-06-30 | ![](https://webarchive.library.unt.edu/eot2008/20081012034354im_/http://www.cancer.gov/images/spacer.gif) | Trial Completion Date | | 2007-11-15 | ![](https://webarchive.library.unt.edu/eot2008/20081012034354im_/http://www.cancer.gov/images/spacer.gif) | Registered in ClinicalTrials.gov | | NCT00004917 | ![](https://webarchive.library.unt.edu/eot2008/20081012034354im_/http://www.cancer.gov/images/spacer.gif) | Date Submitted to PDQ | | 2000-01-13 | ![](https://webarchive.library.unt.edu/eot2008/20081012034354im_/http://www.cancer.gov/images/spacer.gif) | Information Last Verified | | 2003-09-30 | ![](https://webarchive.library.unt.edu/eot2008/20081012034354im_/http://www.cancer.gov/images/spacer.gif) | NCI Grant/Contract Number | | CA21661 |
Note: The purpose of most clinical trials listed in this database is to test new cancer treatments, or new methods of diagnosing, screening, or preventing cancer. Because all potentially harmful side effects are not known before a trial is conducted, dose and schedule modifications may be required for participants if they develop side effects from the treatment or test. The therapy or test described in this clinical trial is intended for use by clinical oncologists in carefully structured settings, and may not prove to be more effective than standard treatment. A responsible investigator associated with this clinical trial should be consulted before using this protocol. Back to Top |
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