A Phase 3 interventional study of palifermin and cisplatin in Head and Neck Cancer, Mucositis and Pain, sponsored by Radiation Therapy Oncology Group. Terminated at 48 sites in 2 countries. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2017-12-26.
Sponsored by Radiation Therapy Oncology Group · Phase 3, Interventional, and Supportive care
RATIONALE: Growth factors, such as palifermin, may lessen the severity of mucositis, or mouth sores, in patients receiving radiation therapy and chemotherapy for head and neck cancer. It is not yet known whether palifermin is more effective than a placebo in lessening mucositis in patients receiving radiation therapy and chemotherapy for head and neck cancer.
PURPOSE: This randomized phase III trial is studying palifermin to see how well it works compared to a placebo in lessening oral mucositis in patients undergoing radiation therapy and chemotherapy for locally advanced head and neck cancer.
OBJECTIVES:
Primary
Secondary
OUTLINE: This is a randomized, double-blind, placebo-controlled, multicenter study. Patients are stratified according to disease stage (III vs IVA or IVB), tumor site (oral cavity or oropharynx vs hypopharynx or larynx), and radiotherapy technique used on study (intensity-modulated radiotherapy [IMRT] vs 3-dimensional conformal radiotherapy [3D-CRT]). Patients are randomized to 1 of 2 treatment arms.
Mucositis, pain, and symptom burden are assessed at baseline, during radiotherapy, and post radiotherapy. Xerostomia is assessed at baseline, during radiotherapy, and several times after completion of study therapy.
After completion of study therapy, patients are followed periodically for 10 years.
PROJECTED ACCRUAL: A total of 298 patients will be accrued for this study.
2,344 studies on the registry are indexed under Head and Neck Neoplasms; 551 are open to participants now.
This study's enrollment of 21 is below the median of 47 across 1,751 interventional studies indexed under Head and Neck Neoplasms.
Browse Head and Neck Neoplasms studies →Radiation Therapy Oncology Group is the lead sponsor of 154 studies on the registry; none are open to participants now.
Counted across the registry records on this site, refreshed daily.
Patients must have at least 2 mucosal sites of the oral cavity/oropharynx mucosa assessable by visual transoral inspection that will receive at least 66 Gy;
-2.1 Patients with tumors of the larynx or hypolarynx are eligible only if it is anticipated that the 2 index sites in the oral cavity/oropharynx mucosa will receive at least 66 Gy;
Selected Stage III (excluding T1N1MO) or IVA-B (AJCC, 6th edition) at study entry, including no distant metastases, based upon the following minimum diagnostic workup:
Adequate bone marrow function, defined as follows:
Adequate renal function with serum creatinine \< 1.5 mg/dl and creatinine clearance (CC) ≥ 50 ml/min within 2 weeks prior to registration determined by 24-hour collection or estimated by Cockcroft-Gault formula:
CCr male = [(140 - age) x (wt in kg)]/[(Serum Cr mg/dl) x (72)] CCr female = 0.85 x (CrCl male)
Exclusion Criteria:
Severe, active co-morbidity, defined as follows:
Concurrent radiation therapy, cisplatin, and palifermin followed by neck dissection for indicated patients.
Biological: palifermin · Drug: cisplatin · Procedure: neck dissection · Radiation: radiation therapy
Concurrent radiation therapy, cisplatin, and placebo followed by neck dissection for indicated patients.
Drug: cisplatin · Other: placebo · Procedure: neck dissection · Radiation: radiation therapy
Four doses of palifermin, 180ųg/kg, administered as an i.v. bolus injection over 30-60 seconds. Starting on day -3 (Friday) prior to radiation therapy / chemotherapy and then once weekly, on days 5, 12, and 19.
Patients will receive cisplatin (100 mg/m2) administered intravenously on days 1, 22, and 43 of the treatment course.
Four doses of placebo, 180ųg/kg, administered as an i.v. bolus injection over 30-60 seconds. Starting on day -3 (Friday) prior to radiation therapy / chemotherapy and then once weekly, on days 5, 12, and 19.
A neck dissection is required for patients with persistent nodal disease, any stage, if a palpable abnormality or worrisome radiographic abnormality persists in the neck 8-9 weeks after completion of therapy. A neck dissection is optional for patients with multiple positive lymph nodes or with lymph nodes exceeding 3 cm in diameter at pre-treatment (N2a, N2b, N3) who achieve a complete clinical and radiographic response in the neck. All patients will be assessed at approximately 8 weeks post-treatment with CT scan or MRI by the same technique used at baseline.
A radiation dose of 70 Gy with at least 66 Gy to at least 2 mucosal sites of the oral cavity/oropharynx mucosa. Radiation therapy can be given with 3D conformal (3D-CRT) or with intensity modulated RT (IMRT) techniques; however, the chosen modality must be used for the entire course of treatment.
Duration of Oral Mucositis as Measured in Terms of Days
Duration in days of World Heath Organization (WHO) Grades 3 and 4 oral mucositis during the acute period (defined to be 105 days \[15 weeks\] or less from the start of treatment); duration is calculated from the onset of a Grade 3 or 4 oral mucositis to the day when an oral mucositis of ≤ Grade 2 is reported after the last oral mucositis of Grade 3 or 4. Patients with grade 0-2 mucositis have a duration of 0. This study required 298 patients to detect via two-sided t-test a reduction of mean duration of at least 9 days from 29 days (standard deviation = 23 days) on the placebo arm with 90% power and alpha = 0.05. Statistical testing was not done due to the small sample size.
Time frame: Twice-weekly from start of treatment up to 15 weeks after the start of treatment.
Number of Patients With Grade 3 or 4 Mucositis as Measured by the World Heath Organization (WHO) Scale
Adverse events are graded using CTCAE v3.0. Grade refers to the severity of the AE. The CTCAE v3.0 assigns Grades 1 through 5 with unique clinical descriptions of severity for each AE based on this general guideline: Grade 1 Mild AE, Grade 2 Moderate AE, Grade 3 Severe AE, Grade 4 Life-threatening or disabling AE, Grade 5 Death related to AE.
Time frame: Twice-weekly from start of treatment up to 15 weeks after the start of treatment.
Time to Onset of Grade 3 or 4 Oral Mucositis as Measured by the World Heath Organization (WHO) Scale
Adverse events are graded using CTCAE v3.0. Grade refers to the severity of the AE. The CTCAE v3.0 assigns Grades 1 through 5 with unique clinical descriptions of severity for each AE based on this general guideline: Grade 1 Mild AE, Grade 2 Moderate AE, Grade 3 Severe AE, Grade 4 Life-threatening or disabling AE, Grade 5 Death related to AE.
Time frame: Twice-weekly from start of treatment up to 15 weeks after the start of treatment.
Overall Survival
An event is death from any cause. Overall survival was not calculated due to the limited number of events. Number of patients with an event is reported.
Time frame: From randomization to maximum follow-up at time of analysis of 21 months
Progression-free Survival
An event is defined as the first occurrence of local, regional, distant disease. Progression-free survival is calculated at the time from registration to the death of progression, death in the absence of progression, or last follow-up. Progression-free survival was not calculated due to the limited number of events. Number of patients with an event is reported.
Time frame: From randomization to maximum follow-up at time of analysis of 21 months
Time to Second Primary Tumor
An event is occurrence of a second primary other than basal cell. Time to second primary tumor was not calculated because there were no events. Number of patients with an event is reported.
Time frame: From randomization to maximum follow-up at time of analysis of 21 months
| Milestone | Placebo | Palifermin |
|---|---|---|
| Started | 10 | 11 |
| Completed | 10 | 11 |
| Not completed | 0 | 0 |
Duration in days of World Heath Organization (WHO) Grades 3 and 4 oral mucositis during the acute period (defined to be 105 days \[15 weeks\] or less from the start of treatment); duration is calculated from the onset of a Grade 3 or 4 oral mucositis to the day when an oral mucositis of ≤ Grade 2 is reported after the last oral mucositis of Grade 3 or 4. Patients with grade 0-2 mucositis have a duration of 0. This study required 298 patients to detect via two-sided t-test a reduction of mean duration of at least 9 days from 29 days (standard deviation = 23 days) on the placebo arm with 90% power and alpha = 0.05. Statistical testing was not done due to the small sample size.
| Days | Placebo | Palifermin |
|---|---|---|
| Duration of Oral Mucositis as Measured in Terms of Days | 32 ± 24 | 13 ± 23 |
Adverse events are graded using CTCAE v3.0. Grade refers to the severity of the AE. The CTCAE v3.0 assigns Grades 1 through 5 with unique clinical descriptions of severity for each AE based on this general guideline: Grade 1 Mild AE, Grade 2 Moderate AE, Grade 3 Severe AE, Grade 4 Life-threatening or disabling AE, Grade 5 Death related to AE.
| Participants | Placebo | Palifermin |
|---|---|---|
| Number of Patients With Grade 3 or 4 Mucositis as Measured by the World Heath Organization (WHO) Scale | 8 | 4 |
Adverse events are graded using CTCAE v3.0. Grade refers to the severity of the AE. The CTCAE v3.0 assigns Grades 1 through 5 with unique clinical descriptions of severity for each AE based on this general guideline: Grade 1 Mild AE, Grade 2 Moderate AE, Grade 3 Severe AE, Grade 4 Life-threatening or disabling AE, Grade 5 Death related to AE.
| days | Placebo | Palifermin |
|---|---|---|
| Time to Onset of Grade 3 or 4 Oral Mucositis as Measured by the World Heath Organization (WHO) Scale | 48 ± 10 | 41 ± 6 |
An event is death from any cause. Overall survival was not calculated due to the limited number of events. Number of patients with an event is reported.
| Participants | Placebo | Palifermin |
|---|---|---|
| Overall Survival | 2 | 0 |
An event is defined as the first occurrence of local, regional, distant disease. Progression-free survival is calculated at the time from registration to the death of progression, death in the absence of progression, or last follow-up. Progression-free survival was not calculated due to the limited number of events. Number of patients with an event is reported.
| Participants | Placebo | Palifermin |
|---|---|---|
| Progression-free Survival | 2 | 0 |
An event is occurrence of a second primary other than basal cell. Time to second primary tumor was not calculated because there were no events. Number of patients with an event is reported.
| Participants | Placebo | Palifermin |
|---|---|---|
| Time to Second Primary Tumor | 0 | 0 |
Non-serious events are listed at a 0% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Placebo | — | 8/10 (80%) | 9/10 (90%) |
| Palifermin | — | 5/11 (45.5%) | 11/11 (100%) |
| Event | Placebo | Palifermin |
|---|---|---|
| MucositisGastrointestinal disorders | 8/10 | 4/11 |
| DehydrationMetabolism and nutrition disorders | 3/10 | 2/11 |
| Weight decreasedInvestigations | 0/10 | 3/11 |
| NauseaGastrointestinal disorders | 2/10 | 0/11 |
| AnorexiaMetabolism and nutrition disorders | 2/10 | 0/11 |
| Dry mouthGastrointestinal disorders | 1/10 | 0/11 |
| DysphagiaGastrointestinal disorders | 1/10 | 1/11 |
| Vomiting NOSGastrointestinal disorders | 1/10 | 0/11 |
| Infection with Grade 3 or 4 neutrophils (ANC <1.0 x 10e9/L): AppendixInfections and infestations | 1/10 | 0/11 |
| Metabolic/laboratory - Other:Investigations | 1/10 | 0/11 |
| Event | Placebo | Palifermin |
|---|---|---|
| Dry mouthGastrointestinal disorders | 7/10 | 9/11 |
| MucositisGastrointestinal disorders | 2/10 | 7/11 |
| Weight decreasedInvestigations | 5/10 | 7/11 |
| DysgeusiaNervous system disorders | 6/10 | 5/11 |
| DysphagiaGastrointestinal disorders | 3/10 | 6/11 |
| FatigueGeneral disorders | 5/10 | 2/11 |
| Leukopenia NOSInvestigations | 5/10 | 3/11 |
| HemoglobinBlood and lymphatic system disorders | 4/10 | 5/11 |
| ConstipationGastrointestinal disorders | 4/10 | 2/11 |
| AnorexiaMetabolism and nutrition disorders | 4/10 | 4/11 |
All eligible patients.
| Age, Continuous(years) | Placebo | Palifermin | Total |
|---|---|---|---|
| Median | 52 (35 to 82) | 55 (48 to 67) | 55 (35 to 82) |
| Sex: Female, Male(Participants) | Placebo | Palifermin | Total |
|---|---|---|---|
| Female | 0 | 1 | 1 |
| Male | 10 | 10 | 20 |
This study is terminated, as verified in Nov 2017. You cannot join it, but the record below documents what was studied.
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