Chemotherapy Before Surgery and Radiation Therapy or Surgery and Radiation Therapy Alone in Treating Patients With Nasal and Paranasal Sinus Cancer That Can Be Removed by Surgery

NCT03493425 — Phase 2, Active not recruiting, 82 participants, ECOG-ACRIN Cancer Research Group

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Phase II Randomized Trial of Neoadjuvant Chemotherapy Followed by Surgery and Post-Operative Radiation Versus Surgery and Post-Operative Radiation for Organ Preservation of T3 and T4a (and Selected T4b) Nasal and Paranasal Sinus Squamous Cell Carcinoma (NPNSCC)

RegistryNCT03493425
StatusActive not recruiting
PhasePhase 2
Study typeInterventional; randomized, parallel, masking: none, treatment
Enrollment82 (Estimated)
SponsorECOG-ACRIN Cancer Research Group (Network); collaborators: National Cancer Institute (NCI)
ConditionsStage III Sinonasal Squamous Cell Carcinoma AJCC v6 and v7, Stage IVA Sinonasal Squamous Cell Carcinoma AJCC v7
InterventionsCarboplatin, Cisplatin, Docetaxel, Image Guided Radiation Therapy, Intensity-Modulated Radiation Therapy, Laboratory Biomarker Analysis, Questionnaire Administration, Therapeutic Conventional Surgery (Drug, radiation, other, procedure)
Datesstart 2019-03-12, primary completion 2029-03-31 (estimated), completion 2029-03-31 (estimated), first posted 2018-04-10, last updated 2026-09-14
Locations154 sites in United States

Related Papers Related Patents Related Grants Related Experts
All trials for Stage III Sinonasal Squamous Cell Carcinoma AJCC v6 and v7 All trials for Stage IVA Sinonasal Squamous Cell Carcinoma AJCC v7 All trials of Carboplatin All trials of Cisplatin

-Summary

This phase II trial studies how well chemotherapy before surgery and radiation therapy works compared to surgery and radiation therapy alone in treating patients with nasal and paranasal sinus cancer that can be removed by surgery. Chemotherapy drugs, such as docetaxel, cisplatin, and carboplatin, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Radiation therapy uses high-energy x-rays to kill tumor cells and shrink tumors. Giving chemotherapy before surgery and radiation therapy may make the tumor smaller and reduce the amount of normal tissue that needs to be removed and treated with radiation.

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+Detailed description

PRIMARY OBJECTIVES:

I. Evaluate the structure preservation rate for patients with locally advanced resectable nasal and paranasal sinus squamous cell carcinoma (NPNSCC) with or without neoadjuvant therapy; all patients will undergo surgical resection and postoperative standard care.

II. Evaluate overall survival (OS) for patients with locally advanced resectable NPNSCC with or without neoadjuvant therapy followed by surgical resection and postoperative standard care.

SECONDARY OBJECTIVES:

I. Evaluate progression-free survival (PFS) for this patient population. II. Examine the rate of structure preservation for the orbit (freedom from orbital exenteration).

III. Evaluate site reported p16 data and correlate with outcome. IV. Determine the accuracy of baseline/post-chemotherapy magnetic resonance imaging (MRI) and/or fludeoxyglucose F-18 positron emission tomography/computed tomography (FDG PET/CT)-based prediction of orbit and skull base preservation.

V. Determine the accuracy of baseline/post-chemotherapy MRI and/or FDG PET/CT-based prediction of 2-year overall survival.

EXPLORATORY TOBACCO USE OBJECTIVES:

I. To determine the effects of tobacco, operationalized as combustible tobacco (1a), other forms of tobacco (1b), and environmental tobacco exposure (ETS) (1c) on provider-reported cancer-treatment toxicity (adverse events \[both clinical and hematologic\] and dose modifications).

II. To determine the effects of tobacco on patient-reported physical symptoms and psychological symptoms.

III. To examine quitting behaviors and behavioral counseling/support and cessation medication utilization.

IV. To explore the effect of tobacco use and exposure on treatment duration, relative dose intensity, and therapeutic benefit.

OUTLINE: Patients are randomized to 1 of 2 arms.

ARM A: Patients undergo standard of care surgery. Beginning 4-6 weeks after surgery, patients undergo image guided intensity modulated radiation therapy (IMRT) once daily (QD) for 5 fractions per week for 30 fractions. Patients with positive margins/positive extracapsular spread (ECS) in lymph nodes undergo image guided IMRT QD for 5 fractions per week for 30 fractions and cisplatin intravenously (IV) over 1-2 hours or carboplatin IV over 30 minutes (for patients who are ineligible to receive cisplatin) weekly for 6 weeks in the absence of disease progression or unacceptable toxicity.

ARM B: Patients receive docetaxel IV over 1 hour and cisplatin IV over 1-2 hours on day 1. Patients who are ineligible to receive cisplatin receive carboplatin IV over 30 minutes on day 1. Treatment repeats every 21 days for up to 3 cycles in the absence of disease progression or unacceptable toxicity. Patients then undergo standard of care surgery no later than 6 weeks following the last dose of chemotherapy. Beginning 4-6 weeks after surgery, patients undergo image guided IMRT QD for 5 fractions per week for 30 fractions. Patients with positive margins/positive ECS in lymph nodes undergo image guided IMRT QD for 5 fractions per week for 30 fractions and cisplatin IV over 1-2 hours or carboplatin IV over 30 minutes (for patients who are ineligible to receive cisplatin) weekly for 6 weeks in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed up every 3 months if < 2 years from study entry and then every 6 months if 2-5 years from study entry.

+Arms and interventions

ArmTypeInterventionsDescription
Arm A (surgery, IMRT, cisplatin, carboplatin)Active comparatorDrug: Carboplatin; Drug: Cisplatin; Radiation: Image Guided Radiation Therapy; Radiation: Intensity-Modulated Radiation Therapy; Other: Laboratory Biomarker Analysis; Other: Questionnaire Administration; Procedure: Therapeutic Conventional SurgeryPatients undergo standard of care surgery. Beginning 4-6 weeks after surgery, patients undergo image guided IMRT QD for 5 fractions per week for 30 fractions. Patients with positive margins/positive ECS in lymph nodes undergo image guided IMRT QD for 5 fractions per week for 30 fractions and cisplatin IV over 1-2 hours or carboplatin IV over 30 minutes (for patients who are ineligible to receive cisplatin) weekly for 6 weeks in the absence of disease progression or unacceptable toxicity.
Arm B (docetaxel, cisplatin, carboplatin, surgery, IMRT)ExperimentalDrug: Carboplatin; Drug: Cisplatin; Drug: Docetaxel; Radiation: Image Guided Radiation Therapy; Radiation: Intensity-Modulated Radiation Therapy; Other: Laboratory Biomarker Analysis; Other: Questionnaire Administration; Procedure: Therapeutic Conventional SurgeryPatients receive docetaxel IV over 1 hour and cisplatin IV over 1-2 hours on day 1. Patients who are ineligible to receive cisplatin receive carboplatin IV over 30 minutes on day 1. Treatment repeats every 21 days for up to 3 cycles in the absence of disease progression or unacceptable toxicity. Patients then undergo standard of care surgery no later than 6 weeks following the last dose of chemotherapy. Beginning 4-6 weeks after surgery, patients undergo image guided IMRT QD for 5 fractions per week for 30 fractions. Patients with positive margins/positive ECS in lymph nodes undergo image guided IMRT QD for 5 fractions per week for 30 fractions and cisplatin IV or carboplatin IV weekly for 6 weeks in the absence of disease progression or unacceptable toxicity.
  • Carboplatin (Drug), also known as Blastocarb, Carboplat, Carboplatin Hexal, Carboplatino, Carboplatinum, Carbosin, Carbosol, Carbotec, CBDCA, Displata, Ercar, JM-8, JM8, Nealorin, Novoplatinum, Paraplatin, Paraplatin AQ, Paraplatine, Platinwas, Ribocarbo: Given IV
  • Cisplatin (Drug), also known as Abiplatin, Blastolem, Briplatin, CDDP, Cis-diammine-dichloroplatinum, Cis-diamminedichloridoplatinum, Cis-diamminedichloro Platinum (II), Cis-diamminedichloroplatinum, Cis-dichloroammine Platinum (II), Cis-platinous Diamine Dichloride, Cis-platinum, Cis-platinum II, Cis-platinum II Diamine Dichloride, Cismaplat, Cisplatina, Cisplatinum, Cisplatyl, Citoplatino, Citosin, Cysplatyna, DDP, Lederplatin, Metaplatin, Neoplatin, Peyrone's Chloride, Peyrone's Salt, Placis, Plastistil, Platamine, Platiblastin, Platiblastin-S, Platinex, Platinol, Platinol- AQ, Platinol-AQ, Platinol-AQ VHA Plus, Platinoxan, Platinum, Platinum Diamminodichloride, Platiran, Platistin, Platosin: Given IV
  • Docetaxel (Drug), also known as Docecad, RP 56976, RP-56976, RP56976, Taxotere, Taxotere Injection Concentrate: Given IV
  • Image Guided Radiation Therapy (Radiation), also known as IGRT, Image Guided Radiotherapy, image-guided radiation therapy, Image-Guided Radiotherapy: Undergo image guided IMRT
  • Intensity-Modulated Radiation Therapy (Radiation), also known as IMRT, Intensity modulated radiation therapy (procedure), Intensity Modulated RT, Intensity-Modulated Radiotherapy, Radiation, Intensity-Modulated Radiotherapy: Undergo image guided IMRT
  • Laboratory Biomarker Analysis (Other): Correlative studies
  • Questionnaire Administration (Other): Ancillary studies
  • Therapeutic Conventional Surgery (Procedure): Undergo standard of care surgery

+Outcome measures

Primary outcomes

  • Structure preservation rate defined as both skull base and orbit being preserved [Up to 5 years]: Fisher's exact test will be used to compare the structure preservation rate between the two arms. The comparison between the two arms for structure preservation will be conducted separately (each at one-sided 0.05 significance level).
  • Overall survival (OS) [From date of randomization, censoring follow-up at last date of contact, assessed for up to 5 years]: Log rank test will be used to compare OS between the two arms. The comparison between the two arms for OS will be conducted separately (each at one-sided 0.05 significance level).

Secondary outcomes

  • Change in accuracy of magnetic resonance imaging (MRI) and fludeoxyglucose F-18 positron emission tomography/computed tomography (FDG PET/CT) to predict orbital and skull base preservation [Baseline and post-chemotherapy]: Receiver operating characteristic (ROC) analysis will be used to assess the ability of using imaging to predict structure preservation. The optimal cut-off points on the ROC curves will be determined by using the Youden's index, which will be used to create the two groups of the baseline/post-chemotherapy MRI markers. Cross-validation will be used to reduce overfitting in the discovery of the optimal cut-off points. After the dichotomization, the structure preservation rate will be computed in each group. The comparison will be done by using Fisher's Exact test. Will repeat the similar analyses using FDG PET/CT and the imaging biomarkers will include standardized uptake value (maximum standardized uptake value and peak standardized uptake value), metabolic tumor volume, total lesion glycolysis, and tumor metabolic heterogeneity derived from PET/CT.
  • OS by imaging biomarkers [From date of randomization, censoring follow-up at last date of contact, assessed at 2 years]: The imaging biomarkers from MRI will include apparent diffusion coefficient from diffusion weighted MRI and tumor volume and margins from gadolinium enhanced T1 images and from PET/CT include focal FDG uptake (greater than liver FDG uptake) involving orbit and skull base, maximum standard uptake value, peak standard uptake value, metabolic tumor volume and total lesion glycolysis. The 2-year OS curve rate will be computed in each group.

+Eligibility

Sex: All, ages: 18 Years to any

Inclusion Criteria:

* Patients must be >= 18 years of age
* Patients must have an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1
* Patients must have a general physical condition compatible with the proposed chemotherapy and surgery
* Patients must have stage T3 or T4a, histologically-confirmed NPNSCC requiring orbital or skull base resection: (Some patients with T4b disease deemed resectable by the treating surgeon can be included provided they fulfill all other eligibility criteria without involvement of the cavernous sinus
* Patients with T4b who have the following characteristics leading to a T4b definition but who in the opinion of the treating surgeon can have resectable disease can be included provided they fulfill all other eligibility criteria and provided they have one of the following presentations: 1. Invasion of orbital apex without involvement of the cavernous sinus 2. Dura invasion depending on extent of involvement and if total resection is deemed feasible. 3. Brain/middle cranial fossa invasion depending on extent of involvement if total resection is deemed feasible. 4. Nasopharynx invasion if very limited 5. Clivus invasion if very limited. (Surgeons are encouraged to consult with the protocol surgical chair for these particular cases). Stages T3 and T4a and selected T4b disease will be included regardless of nodal status (N0 or N1-3), provided that surgical therapy would require orbital or skull base resection. The surgical oncologist in each institution will determine the need for resection of the orbit OR base of skull at baseline for patients on both Arms A and B and following neoadjuvant chemotherapy for patients on Arm B using the score sheet provided at the end of the protocol.

  * Resection of skull base will be deemed necessary according to skull base bone erosion by computed tomography (CT) or marrow involvement by magnetic resonance imaging (MRI) is noted; for any disease abutting the skull base
  * Resection of orbital contents will be deemed necessary according to skull base society guidelines, based on involvement of periorbital fat documented by MRI imaging
* Patients must be deemed surgically resectable by the surgical teams at each institution and must have a determination of degree of anticipated structure preservation of orbit and skull base; this needs to be determined prior to randomization
* Patients must not have received previous irradiation for head and neck tumor, skull base, or brain tumors
* Absolute neutrophil count (ANC) > 1500/mm\^3 (=< 2 weeks prior to randomization)
* Hemoglobin (Hgb) > 8.0 g/dL (=< 2 weeks prior to randomization)
* Platelet count > 100,000/mm\^3 (=< 2 weeks prior to randomization)
* For patients receiving cisplatin, creatinine clearance must be > 60 ml/min (=< 2 weeks prior to randomization); creatinine clearance may be measured or calculated; if calculating, creatinine clearance, use the Cockcroft-Gault formula
* Total bilirubin within 1.5 x the upper limit of normal (ULN) (must be obtained =< 2 weeks prior to randomization)
* Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) must be within 1.5 x ULN allowing for eligibility (must be obtained < 2 weeks prior to randomization)
* Alkaline phosphatase must be within 1.5 x ULN allowing for eligibility (must be obtained < 2 weeks prior to randomization)
* Patients with a prior history of squamous cell or basal carcinoma of the skin or in situ cervical cancer must have been curatively treated
* Patient must not be pregnant or breast-feeding due to the potential harm to an unborn fetus and possible risk for adverse events in nursing infants with the chemotherapy and radiation being used; in addition, complications from pregnancy may interfere with the ability of patients to have an uninterrupted therapy

  * All patients of childbearing potential must have a blood test or urine study within 2 weeks prior to registration to rule out pregnancy
  * A patient of childbearing potential is anyone, regardless of sexual orientation or whether they have undergone tubal ligation, who meets the following criteria: 1) has achived menarche at some point, 2) has not undergone a hysterectomy or bilateral oophorectomy; or 3) has not been naturally postmenopausal for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months)
* Patient must not be expected conceive or father children by using an accepted and effective method(s) of contraception or by abstain from sexual intercourse for the duration of their participation in the study
* Patient must have measurable disease; MRI and/or PET/CT scans need to be performed within 2 weeks prior to randomization

Exclusion Criteria:

* Patients may not be receiving investigational agents at time of randomization, or at any time while on study and during the 4 weeks preceding randomization
* Patients with a history of allergic reactions attributed to compounds of similar chemical or biologic composition to docetaxel and/or both platinum-based chemotherapy agents are ineligible; patient must be able to receive at least one of the two proposed chemotherapy regimens
* Patients with evidence of distant metastases or leptomeningeal disease (LMD) are ineligbile
* Patients with uncontrolled inter-current illnesses which in the opinion of the investigator will interfere with the ability to undergo therapy including chemotherapy are ineligbile
* Patients with a history of a different malignancy are ineligible, unless the disease has not progressed for >= 2 years
* Patient must not have current peripheral neuropathy > grade 2 at time of randomization
* Patient must not have any co-existing condition that would preclude full compliance with the study; no prior history of severe hypersensitivity reaction to docetaxel or other drugs formulated with polysorbate 80

+Locations (154)

FacilityCityCountryStatus
University of Arizona Cancer Center-Orange Grove CampusTucson, ArizonaUnited States
Banner University Medical Center - TucsonTucson, ArizonaUnited States
University of Arizona Cancer Center-North CampusTucson, ArizonaUnited States
Mercy Hospital Fort SmithFort Smith, ArkansasUnited States
Stanford Cancer Institute Palo AltoPalo Alto, CaliforniaUnited States
VA Palo Alto Health Care SystemPalo Alto, CaliforniaUnited States
Smilow Cancer Center/Yale-New Haven HospitalNew Haven, ConnecticutUnited States
Yale UniversityNew Haven, ConnecticutUnited States
UM Sylvester Comprehensive Cancer Center at Coral GablesCoral Gables, FloridaUnited States
UM Sylvester Comprehensive Cancer Center at Deerfield BeachDeerfield Beach, FloridaUnited States
University of Miami Miller School of Medicine-Sylvester Cancer CenterMiami, FloridaUnited States
UM Sylvester Comprehensive Cancer Center at PlantationPlantation, FloridaUnited States
Moffitt Cancer Center-International PlazaTampa, FloridaUnited States
Moffitt Cancer Center - McKinley CampusTampa, FloridaUnited States
Moffitt Cancer CenterTampa, FloridaUnited States
Emory Proton Therapy CenterAtlanta, GeorgiaUnited States
Emory University Hospital MidtownAtlanta, GeorgiaUnited States
Emory University Hospital/Winship Cancer InstituteAtlanta, GeorgiaUnited States
Saint Alphonsus Cancer Care Center-BoiseBoise, IdahoUnited States
Saint Alphonsus Cancer Care Center-CaldwellCaldwell, IdahoUnited States
Kootenai Health - Coeur d'AleneCoeur d'Alene, IdahoUnited States
Idaho Urologic Institute-MeridianMeridian, IdahoUnited States
Saint Alphonsus Cancer Care Center-NampaNampa, IdahoUnited States
Kootenai Clinic Cancer Services - Post FallsPost Falls, IdahoUnited States
Rush-Copley Medical CenterAurora, IllinoisUnited States
Saint Mary's HospitalCentralia, IllinoisUnited States
Northwestern UniversityChicago, IllinoisUnited States
John H Stroger Jr Hospital of Cook CountyChicago, IllinoisUnited States
Rush MD Anderson Cancer CenterChicago, IllinoisUnited States
University of IllinoisChicago, IllinoisUnited States
Carle at The RiverfrontDanville, IllinoisUnited States
Carle Physician Group-EffinghamEffingham, IllinoisUnited States
NorthShore University HealthSystem-Evanston HospitalEvanston, IllinoisUnited States
NorthShore University HealthSystem-Glenbrook HospitalGlenview, IllinoisUnited States
NorthShore University HealthSystem-Highland Park HospitalHighland Park, IllinoisUnited States
Carle Physician Group-Mattoon/CharlestonMattoon, IllinoisUnited States
SSM Health Good SamaritanMount Vernon, IllinoisUnited States
Carle Cancer CenterUrbana, IllinoisUnited States
The Carle Foundation HospitalUrbana, IllinoisUnited States
Saint Anthony Regional HospitalCarroll, IowaUnited States
Iowa Methodist Medical CenterDes Moines, IowaUnited States
UI Health Care Mission Cancer and Blood - Des Moines ClinicDes Moines, IowaUnited States
Broadlawns Medical CenterDes Moines, IowaUnited States
Iowa Lutheran HospitalDes Moines, IowaUnited States
Methodist West HospitalWest Des Moines, IowaUnited States
Central Care Cancer Center - Garden CityGarden City, KansasUnited States
Central Care Cancer Center - Great BendGreat Bend, KansasUnited States
University of Kansas Cancer CenterKansas City, KansasUnited States
Lawrence Memorial HospitalLawrence, KansasUnited States
The University of Kansas Cancer Center - OlatheOlathe, KansasUnited States
University of Kansas Cancer Center-Overland ParkOverland Park, KansasUnited States
Mercy Hospital PittsburgPittsburg, KansasUnited States
Salina Regional Health CenterSalina, KansasUnited States
University of Kansas Health System Saint Francis CampusTopeka, KansasUnited States
University of Kansas Hospital-Westwood Cancer CenterWestwood, KansasUnited States
The James Graham Brown Cancer Center at University of LouisvilleLouisville, KentuckyUnited States
UofL Health Medical Center NortheastLouisville, KentuckyUnited States
Tufts Medical CenterBoston, MassachusettsUnited States
Massachusetts General Hospital Cancer CenterBoston, MassachusettsUnited States
University of Michigan Rogel Cancer CenterAnn Arbor, MichiganUnited States
Henry Ford Cancer Institute-DownriverBrownstown, MichiganUnited States
Henry Ford Macomb Hospital-Clinton TownshipClinton Township, MichiganUnited States
Henry Ford Medical Center-FairlaneDearborn, MichiganUnited States
Wayne State University/Karmanos Cancer InstituteDetroit, MichiganUnited States
Henry Ford HospitalDetroit, MichiganUnited States
Weisberg Cancer Treatment CenterFarmington Hills, MichiganUnited States
Allegiance HealthJackson, MichiganUnited States
Henry Ford Medical Center-ColumbusNovi, MichiganUnited States
Henry Ford Macomb Health Center - Shelby TownshipShelby, MichiganUnited States
Henry Ford West Bloomfield HospitalWest Bloomfield, MichiganUnited States
Sanford Joe Lueken Cancer CenterBemidji, MinnesotaUnited States
Mercy Oncology and Hematology - Clayton-ClarksonBallwin, MissouriUnited States
Central Care Cancer Center - BolivarBolivar, MissouriUnited States
Siteman Cancer Center at Saint Peters HospitalCity of Saint Peters, MissouriUnited States
Siteman Cancer Center at West County HospitalCreve Coeur, MissouriUnited States
Freeman Health SystemJoplin, MissouriUnited States
Mercy Hospital JoplinJoplin, MissouriUnited States
University of Kansas Cancer Center - NorthKansas City, MissouriUnited States
University of Kansas Cancer Center at North Kansas City HospitalNorth Kansas City, MissouriUnited States
Mercy Clinic-Rolla-Cancer and HematologyRolla, MissouriUnited States
Phelps Health Delbert Day Cancer InstituteRolla, MissouriUnited States
Heartland Regional Medical CenterSaint Joseph, MissouriUnited States
Mercy Hospital SpringfieldSpringfield, MissouriUnited States
CoxHealth South HospitalSpringfield, MissouriUnited States
Washington University School of MedicineSt Louis, MissouriUnited States
Mercy Hospital SouthSt Louis, MissouriUnited States
Siteman Cancer Center-South CountySt Louis, MissouriUnited States
Siteman Cancer Center at Christian HospitalSt Louis, MissouriUnited States
Mercy Hospital Saint LouisSt Louis, MissouriUnited States
Billings Clinic Cancer CenterBillings, MontanaUnited States
Bozeman Health Deaconess HospitalBozeman, MontanaUnited States
Benefis Sletten Cancer InstituteGreat Falls, MontanaUnited States
Great Falls ClinicGreat Falls, MontanaUnited States
Logan Health Medical CenterKalispell, MontanaUnited States
Community Medical CenterMissoula, MontanaUnited States
Dartmouth Hitchcock Medical Center/Dartmouth Cancer CenterLebanon, New HampshireUnited States
Memorial Sloan Kettering Basking RidgeBasking Ridge, New JerseyUnited States
Memorial Sloan Kettering MonmouthMiddletown, New JerseyUnited States
Memorial Sloan Kettering BergenMontvale, New JerseyUnited States
Northwell Health Imbert Cancer CenterBay Shore, New YorkUnited States

54 more sites not listed.

+Publications

  • Results publication: Adilbay D, Valero C, Fitzgerald C, Yuan A, Mimica X, Gupta P, Wong RJ, Shah JP, Patel SG, Ganly I, Cohen MA. Outcomes in surgical management of sinonasal malignancy-A single comprehensive cancer center experience. Head Neck. 2022 Apr;44(4):933-942. doi: 10.1002/hed.26989. Epub 2022 Jan 25. PMID 35080076

+Investigators

  • Nabil F Saba, Principal investigator, ECOG-ACRIN Cancer Research Group

+Funding

NIH grants: U10CA180820