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A Phase II Study To Assess The Efficacy of Amifostine for Submandibular and Sublingual Salivary Sparing During Head and Neck Cancer Treatment With Intensity- Modulated Radiation Therapy (IMRT) for Parotid Salivary Sparing


Phase 2
18 Years
N/A
Not Enrolling
Both
Head and Neck Cancer

Thank you

Trial Information

A Phase II Study To Assess The Efficacy of Amifostine for Submandibular and Sublingual Salivary Sparing During Head and Neck Cancer Treatment With Intensity- Modulated Radiation Therapy (IMRT) for Parotid Salivary Sparing


Amifostine is designed to protect the cells in normal tissues against the toxicities of
chemotherapy and radiation therapy.

Before you can start treatment on this study, you will have "screening tests." These tests
will help the doctor decide if you are eligible to take part in this study.

Blood (about 2 tablespoons) will be drawn for routine blood tests. Your complete medical
history will be recorded. You will have a physical exam, including measurement of your
vital signs (blood pressure, heart rate, temperature, and breathing rate), weight, and
height. You will have a dental exam. You will complete a questionnaire that asks questions
about dry mouth. In addition, you will be asked questions about your diet and eating
habits. This should take no longer than 10 minutes. Also, saliva will be collected by a
simple, in-office oral test that measures saliva flow rate over a 5 minute period. Women who
are able to have children must have a negative blood (about 1-2 teaspoons) pregnancy test.

If you are found to be eligible to take part in this study, you will receive IMRT Monday
-Friday over a 6-7 week period. In addition, 2-3 hours before IMRT, you will also take
pre-medications by mouth to prevent potential nausea and skin reactions (anti-nausea &
antihistamine), including drinking water.You will receive daily IMRT therapy, excluding
weekends and holidays. The radiation dose is designed to conform to the 3-dimensional shape
of the tumor by controlling the intensity of the radiation beam to focus a higher radiation
dose on the tumor (and not the surrounding normal tissue). Thirty (30) to 60 minutes before
every IMRT treatment, you will receive study drug in two injections beneath the skin. IMRT
will take about 30 minutes to complete.

Every day that you are receiving IMRT (Monday-Friday), you will be asked about any drugs you
are taking and any side effects you are experiencing. Your vital signs will be recorded.

Every week (Weeks 2-7), you will have a complete oral and physical exam. You will complete
the questionnaire that asks questions about dry mouth. You will be asked questions about
your ability to perform daily activities (performance status evaluation). Your weight will
also be measured. You will be asked to complete the symptom survey (the M.D. Anderson
Symptom Inventory) that will ask you to rate your symptoms and how much the symptoms
interfere in your daily activities.

On the last day you receive IMRT or amifostine (whichever is last), you will have a complete
oral exam and you will complete the questionnaire about dry mouth.

Six (6) weeks after the end of therapy, you will have an end-of-therapy visit. At this
visit, you will have a complete physical and oral exam with a saliva collection. You will
complete the questionnaire about dry mouth. Your weight will be measured, and you will have
a performance status evaluation. Blood (about (2) tablespoons) will be drawn for routine
blood tests. You will be asked about any drugs you are taking and any side effects you are
experiencing. In addition, you will be asked questions about your diet and eating habits.

You will be asked to complete the symptom survey (the M.D. Anderson Symptom Inventory) that
will ask you to rate your symptoms and how much the symptoms interfere in your daily
activities every week for 2 months after the end of radiation therapy. After this point,
you will be asked to complete the symptom survey every month for 1 year.

You will have follow-up visits 4, 7, 10, and 12 months after the end of therapy. At these
visits, you will have a complete oral exam and saliva collection. You will complete the dry
mouth questionnaire. Your weight will be measured, and you will have a performance status
evaluation and you will be asked questions about your diet and eating habits.

THIS IS AN INVESTIGATIONAL STUDY. Amifostine is FDA approved and commercially available.
Amifostine is FDA approved to be given through a needle in your vein but not FDA approved to
be given through a needle under the skin.

Up to 20 patients will take part in this study. All patients will be enrolled at M. D.
Anderson.


Inclusion Criteria:



1. Adult men and women of at least 18 years of age at the time of patient entry;

2. Women of reproductive potential (defined as being <1 year post-menopausal) must have
a negative serum pregnancy test within 7 days of study entry;

3. Men and women of reproductive potential must agree to practice an effective method of
avoiding pregnancy (including oral or implanted contraceptives, intrauterine device
(IUD), female condom, diaphragm with spermicide, cervical cap, use of a condom by the
sexual partner or sterile sexual partner) beginning at the time the informed consent
is signed, and must agree to continue using such precautions while receiving IMRT
through 6 weeks after the last dose of amifostine or RT, whichever is the last
therapy discontinued;

4. Patients undergoing definitive or post-operative IMRT as follows:

5. Definitive Patients: Histology confirmed unknown primary T0N1-2bM0 or oropharynx
Stage I, II, III, IV (TX, T1-T2, favorable T3 (exophytic) N0-N2b, M0), small volume
primary and nodal, not requiring chemotherapy during RT (i.e., induction chemo is
acceptable as well as concurrent biological therapy e.g., Cetuximab), squamous cell
carcinoma (AJCC Staging of HNSCC). Lymph nodes bilaterally of the neck are at risk
for metastatic disease and require irradiation per clinical judgment.

6. Post-operative Patients: Histology confirmed oral cavity, oropharynx, larynx and
hypopharynx squamous cell carcinoma (AJCC Staging of HNSCC): *Stage III and IV
squamous cell carcinoma treated with surgery as the primary modality requiring
post-operative RT, but not receiving concurrent chemotherapy. *Indications for
post-operative RT include: unfavorable T3 and T4 primaries, compromised margins,
nodal metastases, extracapsular nodal extension, perineural invasion and
lymphovascular invasion.

7. Zubrod performance status of 0 or 1

8. Adequate nutritional status as determined by the treating physician in conjunction
with consultation with clinical nutritionists, as indicated.

9. Hemoglobin must be greater than or equal to 10 g/dL.

10. At least one parotid should keep a mean RT dose of < 24-26 Gy. If this cannot be
achieved on one side, then the contralateral parotid dosing goal is to keep the mean
dose as low as possible, typically <15 Gy.

11. It is anticipated that at least one submandibular gland will receive a mean dose
>24-26 Gy.

12. Written informed consent and HIPAA authorization obtained from the patient prior to
receipt of any study medication or beginning study procedures.

Exclusion Criteria:

1. Evidence of significant wound infection, fistula, or major wound dehiscence at time
of patient entry.

2. Carcinomas of the paranasal sinuses, nasopharynx, or N3 at time of patient entry.

3. Presence of prior malignancies <5 years other than non-melanoma skin cancer or
cervical, breast or bladder cancer in situ.

4. T3N0 glottic cancer at time of patient entry.

5. Prior chemotherapy for other cancer within less than or equal to 3 years prior to
patient entry.

6. Planned concurrent or adjuvant chemotherapy.

7. Less than gross total resection for patients on post-operative RT.

8. Prior head neck irradiation except for localized non-melanomatous cutaneous
carcinomas.

9. Salivary gland disease, e.g. Sjogren's disease at time of patient entry.

10. Pregnant or nursing at the time of patient entry or positive serum pregnancy test
within 7 days of study entry.

11. Use of pilocarpine or cevimeline during participation in the study.

12. General medical or psychological conditions that might preclude the patient from
completion of the study or from understanding and signing the informed consent.

13. Evidence of distant metastases.

Type of Study:

Interventional

Study Design:

Allocation: Non-Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment

Outcome Measure:

12-month Clinically Relevant Salivary Flow (CRSF)

Outcome Description:

Primary endpoint is bilateral, 12-month Clinically Relevant Salivary Flow (CRSF) by the submandibular and sublingual salivary glands, collectively. Saliva production will be quantified using selective quantitative submandibular sialometry (total collection time of 5 minutes). A CRSF is equivalent to production of 0.05 mL of saliva post-radiation in a 5-minute collection period.

Outcome Time Frame:

12 months

Safety Issue:

No

Principal Investigator

Mark Chambers, MD

Investigator Role:

Principal Investigator

Investigator Affiliation:

M.D. Anderson Cancer Center

Authority:

United States: Food and Drug Administration

Study ID:

2006-0234

NCT ID:

NCT00409331

Start Date:

December 2006

Completion Date:

January 2009

Related Keywords:

  • Head and Neck Cancer
  • Head and Neck Cancer
  • HNSCC
  • Submandibular and Sublingual Salivary Sparing
  • Amifostine
  • Ethyol
  • Radiation Therapy
  • Head and Neck Neoplasms

Name

Location

U.T. M.D. Anderson Cancer CenterHouston, Texas  77030