Comparing alternative regimens for escalating treatment of intermediate and high-risk oropharyngeal cancer
- Conditions
- Oropharyngeal cancerCancerMalignant neoplasm of oropharynx
- Registration Number
- ISRCTN41478539
- Lead Sponsor
- niversity of Birmingham
- Brief Summary
2024 Protocol article in https://pubmed.ncbi.nlm.nih.gov/38221636/ (added 15/01/2024)
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- Ongoing
- Sex
- All
- Target Recruitment
- 785
Current inclusion criteria as of 28/02/2022:
1. Oropharyngeal squamous cell carcinoma (OPSCC) in base of tongue and tonsil (includes bilateral tumours) and uvula, with an Multidisciplinary Team (MDT) recommendation for treatment with definitive concurrent chemoradiotherapy.
2. All OPC T4 or N3 (HPV-pos and HPV-neg) OR All HPV–neg OPC T1-T4, N1-N3 or T3-4, N0 OR HPV-pos) OPC T1-T4 with N2b-N3, AND who are smokers = 10 pack years current or previous smoking history
3. Minimum life expectancy of 3 months
4. Eastern Cooperative Oncology Group (ECOG) performance status 0-1 (APPENDIX 3)
5. Body weight >30kg
6. Adequate renal function, estimated glomerular filtration rate (eGFR) >50mL/min calculated using Cockcroft-Gault formula (APPENDIX 4)*
7. Adequate bone marrow function (absolute neutrophil count (ANC) =1.5 x 109/L, haemoglobin =9.0g/dL and platelets =100 x 109/L)
8. Adequate liver function i.e. serum bilirubin =1.5 times the upper limit of normal (ULN) ,AST (SGOT)/ ALT(SGPT) =2.5 x institutional upper limit of normal
9. Prothrombin time (PT) =1.5 x ULN or International Normalised Ratio (INR) =1. 5
10. No cancers in previous 5 years, except basal cell carcinoma of skin and cervical intra-epithelial neoplasia (CIN)
11. Age 18-70
12. Written informed consent given for the trial
13. Evidence of post-menopausal status or negative urinary or serum pregnancy test for female premenopausal patients. Women will be considered post-menopausal if they have been amenorrheic for 12 months without an alternative medical cause. The following age-specific requirements apply:
- Women
- Women =50 years of age would be considered post-menopausal if they have been amenorrheic for 12 months or more following cessation of all exogenous hormonal treatments, had radiationinduced menopause with last menses >12 months ago, had chemotherapy-induced menopause with last menses >12 months ago or underwent surgical sterilization (bilateral oophorectomy, bilateral salpingectomy or hysterectomy).
14. Willingness to comply with the protocol for the duration of the study, including undergoing treatment and scheduled visits and examinations including follow up
Previous inclusion criteria:
1. Oropharyngeal squamous cell carcinoma in base of tongue and tonsil with an Multidisciplinary Team recommendation for treatment with definitive concurrent chemoradiotherapy
2. Intermediate risk [HPV +ve OPC with N2b+ disease and greater than 10 pack year history of smoking] or high risk (HPV–ve OPC) as per Ang classification
3. Minimum life expectancy of 3 months
4. Eastern Cooperative Oncology Group (ECOG) performance status 0-1
5. Adequate renal function, glomerular filtration rate >50mL/min calculated using CockcroftGault formula
6. Adequate bone marrow function (absolute neutrophil count =1.5 x 109/L and platelets =100 x 109/L)
7. Adequate liver function i.e. plasma bilirubin =1.5 times the upper limit of normal, and alanine aminotransferase and Alkaline phosphatase =2.5 x upper limit of normal
8. Prothrombin time =1.5 x upper limit of normal or International Normalised Ra
Current exclusion criteria as of 28/02/2022:
1. All T1-T2,N0 OPC (HPV-pos or HPV-neg)
2. HPV positive patients who are:
• T1-T3, N0-N2c non-smokers
• T1-T3, N0-N2c smokers with =10 pack years or
• T1-T3, N0-N2a smokers with =10 pack years
3. Unfit for chemoradiotherapy regimens
4. Creatinine Clearance
5. Treatment with any of the following, prior to randomisation:
a. Any Investigational Medicinal Products (IMP) within 30 days
b. Any other chemotherapy, immunotherapy or anticancer agents within 3 weeks
c. Major surgical procedure (as defined by the Investigator) within 4 weeks, unless for diagnostic urposes
d. Concurrent use of hormonal therapy for non-cancer-related conditions (e.g., hormone replacement therapy is acceptable)
6. History of allergic reactions or hypersensitivity to any of the IMPs and excipients used in this trial
7. Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, uncontrolled hypertension, unstable angina pectoris, cardiac arrhythmia, interstitial lung disease, serious chronic gastrointestinal conditions associated with diarrhoea, including any patient known to have psychiatric illness/social situations that would limit compliance with study requirements, substantially increase the risk of incurring AEs or compromise the ability of the patient to give written informed consent
8. Active infection including tuberculosis (clinical evaluation that includes clinical history, physical examination and radiographic findings, and TB testing in line with local practice), hepatitis B (known positive HBV surface antigen (HBsAg) result), hepatitis C, or human immunodeficiency virus (positive HIV 1/2 antibodies). Patients with a past or resolved HBV infection (defined as the presence of hepatitis B core antibody [anti-HBc] and absence of HBsAg) are eligible. Patients positive for hepatitis C (HCV) antibody are eligible only if polymerase chain reaction is negative for HCV RNA.
9. Women who are pregnant or breast feeding. Women of child-bearing potential must have a negative pregnancy test performed within 7 days prior to randomisation
10. Men or women who are not prepared to practise methods of contraception of proven efficacy during treatment and for 6 months following the end of treatment
11. Any condition that, in the opinion of the Investigator, would interfere with evaluation of study treatment or interpretation of patient safety or study results
12. Any previous treatment with a PD-L or PD-L1 inhibitor, including durvalumab
13. Current or prior use of immunosuppressive medication within 14 days before the first dose of durvalumab. The following are exceptions to this criterion:
• Intranasal, inhaled, topical steroids, or local steroid injections (e.g. intra articular injection)
• Systemic corticosteroids at physiologic doses not to exceed 10 mg/day of prednisone or its equivalent
• Steroids as premedication for hypersensitivity reactions (e.g, CT scan, premedication).
14. Active or prior documented autoimmune or inflammatory disorders including inflamm
Study & Design
- Study Type
- Interventional
- Study Design
- Not specified
- Primary Outcome Measures
Name Time Method
- Secondary Outcome Measures
Name Time Method