Principal Investigator
Enrollment Status
Clinical Trial ID
Clinical Trial Summary
This randomized 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. Drugs used in chemotherapy, 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.
Phase
Phase 2
Funding Agency/Sponsor
National Cooperative Group
Disease
Head and Neck Cancer
Enrollment Eligibility
Inclusion Criteria:
- Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1
- General physical condition compatible with the proposed chemotherapy and surgery
- Stage T3 or T4a, histologically-confirmed NPNSCC requiring orbital or skull base
resection:
- Stages T3 and T4a 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 neo-adjuvant chemotherapy for patients on Arm B
- Resection of skull base will be deemed necessary according to skull base
bone erosion by CT or marrow involvement by MRI is noted; for any disease
abutting the skull base; or for ethmoid sinus or frontal sinus involvement
- 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 may not be receiving investigational agents at time of registration, or at
any time while on study and during the 4 weeks preceding enrollment
- 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 excluded; 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
excluded
- Patients must not have received previous irradiation for head and neck tumor, skull
base, or brain tumors
- Patients with uncontrolled inter-current illnesses which in the opinion of the
investigator will interfere with the ability to undergo therapy including chemotherapy
are excluded
- Patients with a history of a different malignancy are excluded, unless the disease has
not progressed for >= 2 years
- 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
- Creatinine clearance of > 60 ml/min; creatinine clearance may be measured or
calculated; if calculating, creatinine clearance, use the Cockroft-Gault formula =< 2
weeks prior to randomization
- Total bilirubin within normal limits (must be obtained =< 2 weeks prior to
randomization)
- Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) must be within the
range allowing for eligibility, must be obtained < 2 weeks prior to randomization
- Alkaline phosphatase must be within the range 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
- No current peripheral neuropathy > grade 2 at time of randomization
- Patients 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
- Women must not be pregnant or breast-feeding
- All females of childbearing potential must have a blood test or urine study
within 2 weeks prior to registration to rule out pregnancy
- A female of childbearing potential is any woman, regardless of sexual orientation
or whether they have undergone tubal ligation, who meets the following criteria:
1) has not undergone a hysterectomy or bilateral oophorectomy; or 2) 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)
- Women of childbearing potential and sexually active males must be strongly advised to
use an accepted and effective method of contraception or to abstain from sexual
intercourse for the duration of their participation in the study
- Patients must have measurable disease; MRI and/or PET/CT scans need to be performed
within 2 weeks prior to registration