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)
| Registry | NCT03493425 |
|---|---|
| Status | Active not recruiting |
| Phase | Phase 2 |
| Study type | Interventional; randomized, parallel, masking: none, treatment |
| Enrollment | 82 (Estimated) |
| Sponsor | ECOG-ACRIN Cancer Research Group (Network); collaborators: National Cancer Institute (NCI) |
| Conditions | Stage III Sinonasal Squamous Cell Carcinoma AJCC v6 and v7, Stage IVA Sinonasal Squamous Cell Carcinoma AJCC v7 |
| Interventions | Carboplatin, Cisplatin, Docetaxel, Image Guided Radiation Therapy, Intensity-Modulated Radiation Therapy, Laboratory Biomarker Analysis, Questionnaire Administration, Therapeutic Conventional Surgery (Drug, radiation, other, procedure) |
| Dates | start 2019-03-12, primary completion 2029-03-31 (estimated), completion 2029-03-31 (estimated), first posted 2018-04-10, last updated 2026-09-14 |
| Locations | 154 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
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.
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.
| Arm | Type | Interventions | Description |
|---|---|---|---|
| Arm A (surgery, IMRT, cisplatin, carboplatin) | Active comparator | Drug: Carboplatin; Drug: Cisplatin; Radiation: Image Guided Radiation Therapy; Radiation: Intensity-Modulated Radiation Therapy; Other: Laboratory Biomarker Analysis; Other: Questionnaire Administration; Procedure: Therapeutic Conventional Surgery | Patients 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) | Experimental | Drug: 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 Surgery | 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 or carboplatin IV weekly for 6 weeks in the absence of disease progression or unacceptable toxicity. |
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
| Facility | City | Country | Status |
|---|---|---|---|
| University of Arizona Cancer Center-Orange Grove Campus | Tucson, Arizona | United States | |
| Banner University Medical Center - Tucson | Tucson, Arizona | United States | |
| University of Arizona Cancer Center-North Campus | Tucson, Arizona | United States | |
| Mercy Hospital Fort Smith | Fort Smith, Arkansas | United States | |
| Stanford Cancer Institute Palo Alto | Palo Alto, California | United States | |
| VA Palo Alto Health Care System | Palo Alto, California | United States | |
| Smilow Cancer Center/Yale-New Haven Hospital | New Haven, Connecticut | United States | |
| Yale University | New Haven, Connecticut | United States | |
| UM Sylvester Comprehensive Cancer Center at Coral Gables | Coral Gables, Florida | United States | |
| UM Sylvester Comprehensive Cancer Center at Deerfield Beach | Deerfield Beach, Florida | United States | |
| University of Miami Miller School of Medicine-Sylvester Cancer Center | Miami, Florida | United States | |
| UM Sylvester Comprehensive Cancer Center at Plantation | Plantation, Florida | United States | |
| Moffitt Cancer Center-International Plaza | Tampa, Florida | United States | |
| Moffitt Cancer Center - McKinley Campus | Tampa, Florida | United States | |
| Moffitt Cancer Center | Tampa, Florida | United States | |
| Emory Proton Therapy Center | Atlanta, Georgia | United States | |
| Emory University Hospital Midtown | Atlanta, Georgia | United States | |
| Emory University Hospital/Winship Cancer Institute | Atlanta, Georgia | United States | |
| Saint Alphonsus Cancer Care Center-Boise | Boise, Idaho | United States | |
| Saint Alphonsus Cancer Care Center-Caldwell | Caldwell, Idaho | United States | |
| Kootenai Health - Coeur d'Alene | Coeur d'Alene, Idaho | United States | |
| Idaho Urologic Institute-Meridian | Meridian, Idaho | United States | |
| Saint Alphonsus Cancer Care Center-Nampa | Nampa, Idaho | United States | |
| Kootenai Clinic Cancer Services - Post Falls | Post Falls, Idaho | United States | |
| Rush-Copley Medical Center | Aurora, Illinois | United States | |
| Saint Mary's Hospital | Centralia, Illinois | United States | |
| Northwestern University | Chicago, Illinois | United States | |
| John H Stroger Jr Hospital of Cook County | Chicago, Illinois | United States | |
| Rush MD Anderson Cancer Center | Chicago, Illinois | United States | |
| University of Illinois | Chicago, Illinois | United States | |
| Carle at The Riverfront | Danville, Illinois | United States | |
| Carle Physician Group-Effingham | Effingham, Illinois | United States | |
| NorthShore University HealthSystem-Evanston Hospital | Evanston, Illinois | United States | |
| NorthShore University HealthSystem-Glenbrook Hospital | Glenview, Illinois | United States | |
| NorthShore University HealthSystem-Highland Park Hospital | Highland Park, Illinois | United States | |
| Carle Physician Group-Mattoon/Charleston | Mattoon, Illinois | United States | |
| SSM Health Good Samaritan | Mount Vernon, Illinois | United States | |
| Carle Cancer Center | Urbana, Illinois | United States | |
| The Carle Foundation Hospital | Urbana, Illinois | United States | |
| Saint Anthony Regional Hospital | Carroll, Iowa | United States | |
| Iowa Methodist Medical Center | Des Moines, Iowa | United States | |
| UI Health Care Mission Cancer and Blood - Des Moines Clinic | Des Moines, Iowa | United States | |
| Broadlawns Medical Center | Des Moines, Iowa | United States | |
| Iowa Lutheran Hospital | Des Moines, Iowa | United States | |
| Methodist West Hospital | West Des Moines, Iowa | United States | |
| Central Care Cancer Center - Garden City | Garden City, Kansas | United States | |
| Central Care Cancer Center - Great Bend | Great Bend, Kansas | United States | |
| University of Kansas Cancer Center | Kansas City, Kansas | United States | |
| Lawrence Memorial Hospital | Lawrence, Kansas | United States | |
| The University of Kansas Cancer Center - Olathe | Olathe, Kansas | United States | |
| University of Kansas Cancer Center-Overland Park | Overland Park, Kansas | United States | |
| Mercy Hospital Pittsburg | Pittsburg, Kansas | United States | |
| Salina Regional Health Center | Salina, Kansas | United States | |
| University of Kansas Health System Saint Francis Campus | Topeka, Kansas | United States | |
| University of Kansas Hospital-Westwood Cancer Center | Westwood, Kansas | United States | |
| The James Graham Brown Cancer Center at University of Louisville | Louisville, Kentucky | United States | |
| UofL Health Medical Center Northeast | Louisville, Kentucky | United States | |
| Tufts Medical Center | Boston, Massachusetts | United States | |
| Massachusetts General Hospital Cancer Center | Boston, Massachusetts | United States | |
| University of Michigan Rogel Cancer Center | Ann Arbor, Michigan | United States | |
| Henry Ford Cancer Institute-Downriver | Brownstown, Michigan | United States | |
| Henry Ford Macomb Hospital-Clinton Township | Clinton Township, Michigan | United States | |
| Henry Ford Medical Center-Fairlane | Dearborn, Michigan | United States | |
| Wayne State University/Karmanos Cancer Institute | Detroit, Michigan | United States | |
| Henry Ford Hospital | Detroit, Michigan | United States | |
| Weisberg Cancer Treatment Center | Farmington Hills, Michigan | United States | |
| Allegiance Health | Jackson, Michigan | United States | |
| Henry Ford Medical Center-Columbus | Novi, Michigan | United States | |
| Henry Ford Macomb Health Center - Shelby Township | Shelby, Michigan | United States | |
| Henry Ford West Bloomfield Hospital | West Bloomfield, Michigan | United States | |
| Sanford Joe Lueken Cancer Center | Bemidji, Minnesota | United States | |
| Mercy Oncology and Hematology - Clayton-Clarkson | Ballwin, Missouri | United States | |
| Central Care Cancer Center - Bolivar | Bolivar, Missouri | United States | |
| Siteman Cancer Center at Saint Peters Hospital | City of Saint Peters, Missouri | United States | |
| Siteman Cancer Center at West County Hospital | Creve Coeur, Missouri | United States | |
| Freeman Health System | Joplin, Missouri | United States | |
| Mercy Hospital Joplin | Joplin, Missouri | United States | |
| University of Kansas Cancer Center - North | Kansas City, Missouri | United States | |
| University of Kansas Cancer Center at North Kansas City Hospital | North Kansas City, Missouri | United States | |
| Mercy Clinic-Rolla-Cancer and Hematology | Rolla, Missouri | United States | |
| Phelps Health Delbert Day Cancer Institute | Rolla, Missouri | United States | |
| Heartland Regional Medical Center | Saint Joseph, Missouri | United States | |
| Mercy Hospital Springfield | Springfield, Missouri | United States | |
| CoxHealth South Hospital | Springfield, Missouri | United States | |
| Washington University School of Medicine | St Louis, Missouri | United States | |
| Mercy Hospital South | St Louis, Missouri | United States | |
| Siteman Cancer Center-South County | St Louis, Missouri | United States | |
| Siteman Cancer Center at Christian Hospital | St Louis, Missouri | United States | |
| Mercy Hospital Saint Louis | St Louis, Missouri | United States | |
| Billings Clinic Cancer Center | Billings, Montana | United States | |
| Bozeman Health Deaconess Hospital | Bozeman, Montana | United States | |
| Benefis Sletten Cancer Institute | Great Falls, Montana | United States | |
| Great Falls Clinic | Great Falls, Montana | United States | |
| Logan Health Medical Center | Kalispell, Montana | United States | |
| Community Medical Center | Missoula, Montana | United States | |
| Dartmouth Hitchcock Medical Center/Dartmouth Cancer Center | Lebanon, New Hampshire | United States | |
| Memorial Sloan Kettering Basking Ridge | Basking Ridge, New Jersey | United States | |
| Memorial Sloan Kettering Monmouth | Middletown, New Jersey | United States | |
| Memorial Sloan Kettering Bergen | Montvale, New Jersey | United States | |
| Northwell Health Imbert Cancer Center | Bay Shore, New York | United States |
54 more sites not listed.
NIH grants: U10CA180820