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Sponsors and Collaborators: |
University of Kentucky Bristol-Myers Squibb |
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Information provided by: | University of Kentucky |
ClinicalTrials.gov Identifier: | NCT00176254 |
This study utilizes two cycles of Paclitaxel and Carboplatin chemotherapies followed by four small doses of radiation, prior to other treatment (surgery or radiation). This study is evaluating if radiation as a chemoenhancer increases the response rate of initial therapy.
Condition | Intervention | Phase |
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Squamous Cell Carcinoma |
Radiation: Radiotherapy Drug: Paclitaxel Drug: Carboplatin |
Phase II |
Study Type: | Interventional |
Study Design: | Treatment, Non-Randomized, Open Label, Uncontrolled, Single Group Assignment, Safety/Efficacy Study |
Official Title: | Paclitaxel, Carboplatin and Radiotherapy as Induction Therapy in Locally Advanced Head and Neck Cancer |
Enrollment: | 41 |
Study Start Date: | May 2000 |
Estimated Primary Completion Date: | November 2002 (Final data collection date for primary outcome measure) |
Arms | Assigned Interventions |
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1: Experimental |
Radiation: Radiotherapy
80 cGy on Day 1 & 2 and 22 & 23 of chemotherapy
Drug: Paclitaxel
225 mg/m2 intravenously over three hours on Days 1 and 22
Drug: Carboplatin
AUC of 6 will be given intravenously over 30 minutes on days 1 and 22
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Cancers of the head and neck (H&N) comprise 5% of all cancers, with 40,000 new cases diagnosed annually. Surgery followed by irradiation or irradiation alone has been the standard of care for locally advanced Stage III and IV patients. With this approach, fewer than 30% of patients achieve long-term remission, and most recur locoregionally. Neoadjuvant chemotherapy has been administered prior to definitive therapy with response rates ranging from 60-90%; with pathologic CR rates documented in 30-70% of clinical responders. However, large randomized trials have shown no improvement in overall survival.
Because induction chemotherapy alone does not appear to improve long-term disease free survival in advanced head and neck cancers, concomitant chemotherapy and radiation has been pursued in patients with locally advanced head and neck cancers. Improved disease-free survival has been demonstrated with a variety of agents. The concept of synergy between radiation and chemotherapy is well established in vitro. Various schedules of radiation and chemotherapy have been utilized including weekly chemotherapy during radiation, chemotherapy given every three weeks during hyperfractionated radiation and alternating chemotherapy and radiation.
One exciting new chemotherapeutic agent, Paclitaxel has been shown to radiosensitize cancer cell lines in vitro. Recent studies have added Carboplatin to Paclitaxel in tandem or concurrently with radiation in hopes of improving response rates. From in-vitro data, it appears that the optimum schedule for the combination of Paclitaxel and radiation is to first induce G2/M arrest with Paclitaxel and follow this with radiation therapy. In a recent study by Chendil, et al, a novel radiation scheme appeared to enhance the response of both p53 wild type and p53 mutant cancer cell lines to chemotherapy. In vitro data with Carboplatin also indicates an additive effect when given prior to irradiation using various cell lines. What has not been evaluated, is whether a neoadjuvant regimen of Paclitaxel and Carboplatin followed by 4 small fractions of radiation can be given safely and effect an improved response rate in patients with bulky T2, Stage III and IV H&N cancer. We propose the use of two cycles of Paclitaxel and Carboplatin followed by four small fractions of radiation, prior to definitive treatment (surgery or radiation). It is hoped that using radiation as a chemoenhancer will increase the response rate to induction therapy in this population of patients.
Ages Eligible for Study: | 18 Years and older |
Genders Eligible for Study: | Both |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
Patients will be medically fit for undergoing chemotherapy. Specifically:
Creatinine Clearance greater than 50 ml/min
Using an actual or calculated creatinine clearance using the formula:
(140 - age) x (wgt in kg)*/(serum creatinine)x(72)*= multiply by 0.85 for females
Exclusion Criteria:
Responsible Party: | University of Kentucky ( Susanne Arnold, MD, Associate Professor of Medicine ) |
Study ID Numbers: | 00-H&N-11-BMS |
Study First Received: | September 9, 2005 |
Last Updated: | June 25, 2008 |
ClinicalTrials.gov Identifier: | NCT00176254 |
Health Authority: | United States: Institutional Review Board |
head and neck squamous cell carcinoma squamous cell carcinoma |
paclitaxel carboplatin radiotherapy induction therapy |
Epidermoid carcinoma Paclitaxel Squamous cell carcinoma Head and Neck Neoplasms Carcinoma, squamous cell |
Carboplatin Neoplasms, Squamous Cell Carcinoma, Squamous Cell Neoplasms, Glandular and Epithelial Carcinoma |
Neoplasms Neoplasms by Site Neoplasms by Histologic Type Molecular Mechanisms of Pharmacological Action Antineoplastic Agents Therapeutic Uses |
Mitosis Modulators Tubulin Modulators Antimitotic Agents Antineoplastic Agents, Phytogenic Pharmacologic Actions |