AzTrials
AzTrials

HPV Positive Oropharyngeal Squamous Cell CarcinomaPhase 3HPVOropharynxNCT01855451

Weekly Cetuximab/RT Versus Weekly Cisplatin/RT in HPV-Associated Oropharyngeal Squamous Cell Carcinoma

A Phase 3 study testing Cetuximab, RT (70 Gy in 35 fractions) and Cisplatin in people with HPV Positive Oropharyngeal Squamous Cell Carcinoma, run by Trans Tasman Radiation Oncology Group at 16 sites in 2 countries.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
Search all trials

Trial summary

A standard treatment for patients with head and neck cancer is radiation given with high doses of a chemotherapy drug called cisplatin, given every 3 weeks during the radiation. This treatment is effective but can significantly increase side effects such as difficulty with swallowing, a sore mouth, fatigue, hearing… Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Cetuximab, RT (70 Gy in 35 fractions) and Cisplatin
Could I receive a placebo?
No, everyone receives an active treatment
How many people
189 participants
Where
16 sitesin 2 countries
Study dates
3 Jun 2013to 23 Aug 2023
Phase
Phase 3
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Aged 18 years or older
  • Has provided written Informed Consent for participation in this trial
  • Histologically confirmed squamous cell carcinoma of the oropharynx with p16 positive status confirmed locally by immunohistochemistry
  • Stage III (excluding T1-2N1) or stage IV (excluding T4, N3, and distant metastasis) if smoking history of < /=10 pack years. If > 10 pack years nodal disease must be N0 - N2a.
  • If an excisional biopsy has been performed, patients remain eligible for the study provided there is clinically measurable disease prior to commencing RT. The residual disease should still meet the stage criteria required for the trial e.g. excisional biopsy of a node with residual T3 primary, or tonsillectomy for T1 primary with residual > N2a nodes.
  • No prior treatment for oropharyngeal cancer
Show all 17Show fewer
  • Adequate haematological, renal, and hepatic function as defined by,
  • Absolute neutrophil count (ANC, segs + bands) > /= 1.5 x 109/L
  • Platelet count > /= 100 x 109/L
  • Total bilirubin < /= 1.5 x upper normal limit
  • ALT < /= 2.5 x upper normal limit
  • Calculated creatinine clearance (Cockcroft-Gault formula) or isotopic GFR > 55ml/min
  • ECOG performance status score of 0-1
  • Participants capable of childbearing are using adequate contraception and intend to continue use of contraception for at least 6 months following completion of treatment
  • Negative pregnancy test within 72 hours prior to randomisation of women who are of childbearing potential
  • Suitable for follow-up for at least 24 months as per trial protocol.
  • Sufficient proficiency in English, cognitive capacity and willingness to complete questionnaires

Who cannot join

  • History of unknown primary of the head and neck
  • T4, N3 or distant metastases
  • Smoking history >10 pack years with N2b or c nodal status
  • Women who are pregnant or lactating.
  • Previous radiotherapy to the area to be treated (excluding superficial radiotherapy for a cutaneous malignancy)
  • Previous cisplatin or carboplatin chemotherapy
Show all 17Show fewer
  • Prior EGFR targeted therapy of any kind
  • Primary surgery to the affected area (excisional biopsy allowed)
  • Peripheral neuropathy > /= grade 2 (CTCAE v4.0)
  • Sensori-neural hearing impairment >= grade 2 (CTCAE v4.0, hearing impaired, not enrolled on a monitoring program) which may be exacerbated by cisplatin (Audiometric abnormalities without corresponding clinical deafness will not be grounds for exclusion)
  • Tinnitus > /= grade 2 (CTCAE v4.0)
  • History of interstitial lung disease or evidence of interstitial lung disease on pre-registration CT
  • History of myocardial infarction within 12 months prior to study entry, uncontrolled congestive heart failure, unstable angina, active cardiomyopathy, unstable arrhythmia, uncontrolled psychotic disorders, active serious infections, active peptic ulcer disease, immunosuppression due to post-organ transplantation or use of immunosuppressants for autoimmune disorders
  • Patients known to be HIV positive
  • Other cancer that was diagnosed:
  • more than 5 years prior to current diagnosis with (i) subsequent evidence of disease recurrence or (ii) clinical expectation of recurrence is greater than 10% or
  • within 5 years of the current diagnosis, with the exception of successfully treated basal cell or squamous cell skin carcinoma, in situ melanoma, or carcinoma in situ of the cervix

Trial locations and contacts

16 sites in 2 countries.

16 sites in 2 countries

Australia14 sites
  • Flinders Medical Centre

    Bedford Park, South Australia, 5042

  • Chris O'Brien Lifehouse

    Camperdown, New South Wales, 2050

  • Canberra Hospital

    Canberra, Australian Capital Territory

  • Peter MacCallum Cancer Centre

    East Melbourne, Victoria, 3002

  • Royal Brisbane and Womens Hospital

    Herston, Queensland, 4006

  • Liverpool Hospital

    Liverpool, New South Wales, 2170

  • Austin Hospital

    Melbourne N., Victoria, 3084

  • Sir Charles Gairdner

    Nedlands, Western Australia, 6009

  • St George Hospital

    Saint George, New South Wales, 2217

  • Townsville Hospital

    Townsville, Queensland, 4810

  • Riverina Cancer Care Centre

    Wagga Wagga, New South Wales

  • Calvary Mater Newcastle

    Waratah, New South Wales

  • Westmead Hospital

    Westmead, New South Wales, 2145

  • Princess Alexandra Hospital

    Woolloongabba, Queensland, 4102

Other trials in Australia

New Zealand2 sites
  • Auckland City Hospital

    Auckland, 1344

  • Palmerston North Hospital

    Palmerston, 4442

Other trials in New Zealand

About this study

Official title: TROG12.01 A Randomised Trial of Weekly Cetuximab and Radiation Versus Weekly Cisplatin and Radiation in Good Prognosis Locoregionally Advanced HPV-Associated Oropharyngeal Squamous Cell Carcinoma

A standard treatment for patients with head and neck cancer is radiation given with high doses of a chemotherapy drug called cisplatin, given every 3 weeks during the radiation. This treatment is effective but can significantly increase side effects such as difficulty with swallowing, a sore mouth, fatigue, hearing loss, ringing in the ears and kidney failure. In Australia, a commonly used treatment HPV-Associated Oropharyngeal Squamous Cell Carcinoma is a lower dose of cisplatin given weekly during the radiation. The high dose and low dose schedules result in a similar total dose of cisplatin being given during the radiation, but it is thought that the weekly schedule results in fewer side effects while maintaining effectiveness.

Another approach widely used around the world for patients with head and neck cancer, is to administer the antibody, cetuximab, weekly during radiation. Cetuximab has a very different side effect profile to cisplatin, and has been reported to result in less exacerbation of radiation related side effects. Both cetuximab and cisplatin can reduce the growth of a cancer and increase the effectiveness of radiation. Both cisplatin and cetuximab appear to be effective treatments in combination with radiation, but have not been directly compared.

The purpose of this study is to compare the treatment related side effects (both acute and longer term) between the cisplatin and cetuximab regimens. Both treatments would be given with the same dose of radiation therapy over 7 weeks. The results of this trial will help determine the optimal treatment for patients with HPV-Associated Oropharyngeal Squamous Cell Carcinoma.

Read the detailed description

Human Papilloma Virus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) is increasing in incidence and has an improved prognosis compared to other head and neck malignancies when treated with standard combination chemoradiation.

The current standard regimen of high dose cisplatin and Radiation Therapy (RT) for head and neck cancer patients results in significant toxicity and is at the limits of tolerance. The excellent prognosis of patients with HPV-positive OPSCC raises concerns about overtreatment with the current standard of care, resulting in unnecessary acute and late morbidity.

Therefore, investigation of chemo-sparing or chemo-modified regimens with RT for HPV-associated OPSCC that do not compromise efficacy is warranted. A number of regimens less intensive than high dose cisplatin are being used in clinical practice for patients with good prognosis HPV OPSCC, but no comparative trials have been performed in this population. The trial population will be restricted to low risk HPV-associated OPSCC.

Trial Arms:

A- RT (70 Gy in 35 fractions, 5 days a week over 7 weeks) with weekly Cetuximab (400 mg/m2 loading dose IV prior to radiation, followed by weekly cetuximab 250 mg/m2 for the duration of the radiotherapy) B- RT(70 Gy in 35 fractions, 5 days a week over 7 weeks) with weekly Cisplatin (40 mg/m2 IV for the duration of the radiotherapy)

Hypothesis: In patients with locally advanced HPV-associated OPSCC, those treated with weekly cetuximab and conventionally fractionated radiotherapy will experience less acute symptom severity than patients receiving weekly cisplatin and conventionally fractionated radiotherapy.

Patients will be followed weekly during treatment, then at 1, 3, 5, 9, 13 weeks post-treatment and at months 6, 9, 12, 15, 18, 21, 24, 28, 32, 36, 42, 48, 54, and 60 post-completion of treatment. Follow-up for the trial will cease when the last patient accrued has a minimum of 2 years follow-up i.e. has attended the 24 months post-treatment review.

Being tested
Cetuximab, RT (70 Gy in 35 fractions), Cisplatin
Keywords
Human Papilloma Virus, HPV, Oropharyngeal, Squamous Cell, Carcinoma
Medical subject headings
Carcinoma

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

Study groups in NCT01855451
Study groupRoleWhat they receive
Radiation Therapy + CetuximabActive comparatorRT (70 Gy in 35 fractions, 5 days a week over 7 weeks) with weekly Cetuximab (400 mg/m2 loading dose IV prior to radiation, followed by weekly cetuximab 250 mg/m2 for the duration of the radiotherapy)
Receives: Drug: Cetuximab; Radiation: RT (70 Gy in 35 fractions)
Radiation Therapy + CisplatinActive comparatorRT(70 Gy in 35 fractions, 5 days a week over 7 weeks) with weekly Cisplatin (40 mg/m2 IV for the duration of the radiotherapy)
Receives: Radiation: RT (70 Gy in 35 fractions); Drug: Cisplatin

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Symptom Severity

    The area under curve of symptom severity between weekly cisplatin and Radiotherapy Therapy (RT) versus weekly cetuximab and RT from baseline to week 20 (13 weeks post-completion of radiotherapy) as measured by M.D. Anderson Symptom Inventory - Head and Neck Module (MDASI-HN).

    Measured: 20 weeks

Secondary outcomes (17)
  1. Symptom severity

    Symptom severity measured by MDASI-HN (Symptom Interference Score, Symptom Score, Symptom Clusters and individual item scores at individual time points)and by Functional Assessment of Cancer Therapy - Head and Neck (FACT-HN).

    Measured: 24 months

  2. Interference of symptoms with daily life

    To compare interference of symptoms with daily life using the MDASI-HN Symptom Interference Score and Quality adjusted life years (QALYs) using the EQ-5D-5L

    Measured: 24 mths

  3. Psychological distress

    To compare psychological distress measured by FACT-HN domain scores and depression and anxiety scales of Hospital Anxiety and Depression Scale (HADS)

    Measured: 36 months

  4. Impact on Health Related Quality of Life

    Measured: 36 months

  5. Swallowing dysfunction

    To compare swallowing dysfunction by Functional swallowing outcome (video fluoroscopy), CTCAE (v4.0) dysphagia, MDASI and FACT questionnaires, enteral feeding rates.

    Measured: 12 months

  6. Speech and dietary function

    To compare speech and dietary function as measured by the Performance Status Scale for Head \& Neck Cancer Patients (PSS-HN)

    Measured: 36 months

  7. Clinician-assessed acute and late toxicity

    To compare clinician-assessed acute and late toxicity using toxicity grading (CTCAE v4.0) - reported as worst toxicity and as overall acute toxicity burden (T-score)

    Measured: 60 months

  8. Rate of enteral feeding

    To compare rate of enteral feeding at 12 months following treatment using Barnard's exact test for the comparison of two proportions

    Measured: 12 months

  9. Hearing impairment

    To compare hearing impairment, as measured by total score of the Hearing Handicap Inventory for adults, screening version (HHIA-S) and audiometry (results will be evaluated according to CTCAE 3 and 4 criteria, Brock criteria, Chang criteria and SIOP Boston Ototoxicity Scale).

    Measured: 24 months

  10. Time to locoregional failure

    To compare time to locoregional failure primarily determined by evidence of progression or recurrence clinically or radiologically

    Measured: 36 months

  11. Failure-free survival

    To compare failure-free survival by clinical and radioloigical assessments

    Measured: 36 months

  12. Overall survival

    To compare overall survival by clinical assessment.

    Measured: 60 months

  13. Pattern of disease failure

    Pattern of disease failure (locoregional [recurrence at primary tumour site and/or regional nodes], distant, both) as assessed radiologically.

    Measured: 36 months

  14. Complete response rate

    To compare FDG-PET-CT complete response rate at week 20

    Measured: 20 weeks

  15. Cost of health resource utilisation

    To compare cost of health resource utilisation via questionnaires EQ-5D-5L and RTOG return to work questionnaire.

    Measured: 24 months

  16. Work status and time to return to work

    To compare work status and time to return to work by RTOG questionnaire

    Measured: 24 months

  17. Potential prognostic markers

    To correlate several potential prognostic markers (including but not limited to EGFR protein level, EGFR copy number, ERCC1, plasma hepatocyte growth factor level, and plasma IL-8) with failure-free survival, overall survival and time to locoregional failure.

    Measured: 60 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted16 May 2013 (estimated)
  2. Study start3 Jun 2013
  3. Primary completion30 Apr 2020
  4. Study completion23 Aug 2023 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
189 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01855451
Sponsor's protocol ID
TROG 12.01
Other IDs
ACTRN12613000279729
Acronym
HPVOropharynx
Status last verified
Nov 2022
First submitted
13 May 2013
Last updated
18 Nov 2022
Results posted
No
Data monitoring committee
Yes

Publications

  • Rischin D, King M, Kenny L, Porceddu S, Wratten C, Macann A, Jackson JE, Bressel M, Herschtal A, Fisher R, Fua T, Lin C, Liu C, Hughes BGM, McGrath M, McDowell L, Corry J. Randomized Trial of Radiation Therapy With Weekly Cisplatin or Cetuximab in Low-Risk HPV-Associated Oropharyngeal Cancer (TROG 12.01) - A Trans-Tasman Radiation Oncology Group Study. Int J Radiat Oncol Biol Phys. 2021 Nov 15;111(4):876-886. doi: 10.1016/j.ijrobp.2021.04.015. Epub 2021 Jun 4.

    PubMed 34098030

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Cetuximab, RT (70 Gy in 35 fractions) and Cisplatin in people with HPV Positive Oropharyngeal Squamous Cell Carcinoma, run by Trans Tasman Radiation Oncology Group at 16 sites in 2 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 17 inclusion and 17 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 18 Nov 2022. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 16 sites in Australia, New Zealand. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Symptom Severity (time frame: 20 weeks). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT01855451, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 18 Nov 2022.

Free account

Log in to keep searching

You’ve used your 3 free searches. AzTrials is free: log in or create a free account to keep searching clinical trials and save the ones you want to follow.

Create a free accountLog in