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A Randomized Phase III Trial to Assess the Effect of Erythropoietin on Local-Regional Control in Anemic Patients Treated With Radiotherapy for Carcinoma of the Head and Neck


Phase 3
18 Years
N/A
Not Enrolling
Both
Anemia, Head and Neck Cancer

Thank you

Trial Information

A Randomized Phase III Trial to Assess the Effect of Erythropoietin on Local-Regional Control in Anemic Patients Treated With Radiotherapy for Carcinoma of the Head and Neck


OBJECTIVES:

Primary

- Determine whether epoetin alfa given during definitive radiotherapy or
chemoradiotherapy improves the local-regional control rate in anemic patients with
squamous cell carcinoma of the head and neck.

Secondary

- Determine whether this drug improves survival in this patient population.

- Identify patterns in first failure in these patients.

- Determine whether there is a significant increase in hemoglobin level between the
baseline value and the value at 28 days after starting epoetin alfa in these patients.

- Assess the toxicity of this regimen in these patients.

OUTLINE: This is a randomized study. Patients are stratified according to stage (I/II vs
III/IV without chemotherapy vs III/IV with chemotherapy), pretreatment hemoglobin level (9.0
to less than 11.5 g/dL vs 11.5 to 13.5 g/dL), and gender. Patients are randomized to one of
two treatment arms.

- Arm I: Patients with stage I or II disease undergo radiotherapy once daily for 6-7
weeks. Patients with stage III or IV disease undergo radiotherapy once daily for 3.5
weeks and then twice daily (6 hours apart) for 2.5 weeks for a total of 6 weeks.

- Arm II: Patients undergo radiotherapy as in arm I. Beginning 7-10 days before
radiotherapy, patients receive epoetin alfa subcutaneously once weekly until the end of
radiotherapy.

Patients with stage III/IV disease may receive concurrent cisplatin IV over 1-2 hours on
days 1 and 22 of radiotherapy.

Patients are followed every 3 months for 2 years, every 6 months for 3 years, and then
annually thereafter.

PROJECTED ACCRUAL: A total of 372 patients (186 per arm) will be accrued for this study
within 3.5 years.

Inclusion Criteria


DISEASE CHARACTERISTICS:

- Histologically confirmed invasive squamous cell carcinoma of the head and neck,
including carcinoma arising from the oral cavity, oropharynx, larynx, and hypopharynx

- Stage I-IV disease

- No distant metastases

- No carcinoma of the nasopharynx, nasal cavity/paranasal sinuses, or salivary
glands

- No carcinoma in situ without an identifiable invasive component

- Plan for radiotherapy in continuous course

- Prior surgical exploration with gross residual disease remaining allowed

- Prior neck dissection with or without biopsy of primary tumor, but no radical surgery
for primary tumor, allowed

- Anemia, defined as hemoglobin no greater than 13.5 g/dL for males and no greater than
12.5 g/dL for females (transfusion prior to study allowed)

- No severe anemia (i.e., hemoglobin less than 9.0 g/dL)

- No anemia confirmed to be due to causes other than chronic disease (e.g., iron
deficiency anemia)

- Not entered on other RTOG head and neck protocols

PATIENT CHARACTERISTICS:

Age:

- 18 and over

Performance status:

- Zubrod 0-2

Life expectancy:

- Not specified

Hematopoietic:

- See Disease Characteristics

- Stage III/IV patients receiving concurrent cisplatin:

- Absolute neutrophil count at least 2,000/mm^3

- Platelet count at least 100,000/mm^3

Hepatic:

- Not specified

Renal:

- Stage III/IV patients receiving concurrent cisplatin:

- Creatinine no greater than 1.5 mg/dL

- Creatinine clearance at least 50 mL/min

Cardiovascular:

- No malignant or poorly controlled hypertension (e.g., symptomatic hypertension or
diastolic blood pressure of 100 mm Hg or greater despite antihypertensive medication)

- No unstable angina or other poorly controlled cardiac disease

Other:

- Not pregnant or nursing

- Negative pregnancy test

- Fertile patients must use effective contraception

- If stage III or IV disease is present, willing to come for twice daily radiotherapy
for the last 2.5 weeks of therapy

- No active infection requiring IV antibiotics

- No unexplained fever

- No AIDS or other history of congenital or acquired immunodeficiency

- No other malignancies within the past 3 years except carcinoma in situ or
nonmelanomatous skin cancer

- No known hypersensitivity to mammalian cell-derived products or to human albumin

- No acute/subacute illness that would make the need for transfusion likely

PRIOR CONCURRENT THERAPY:

Biologic therapy:

- At least 4 weeks since other prior cytokine therapy (e.g., filgrastim [G-CSF],
interleukins, or interferons)

- No prior epoetin alfa

- No other concurrent cytokine therapy

Chemotherapy:

- No prior chemotherapy

- Concurrent cisplatin, paclitaxel/cisplatin, or paclitaxel/carboplatin for patients
with stage III/IV disease is allowed

Endocrine therapy:

- Not specified

Radiotherapy:

- See Disease Characteristics

- No prior radiotherapy to the head and neck

Surgery:

- See Disease Characteristics

Other:

- No concurrent amifostine

- No concurrent transfusion

Type of Study:

Interventional

Study Design:

Allocation: Randomized, Primary Purpose: Treatment

Principal Investigator

Mitchell Machtay, MD

Investigator Role:

Study Chair

Investigator Affiliation:

Abramson Cancer Center of the University of Pennsylvania

Authority:

United States: Federal Government

Study ID:

CDR0000067599

NCT ID:

NCT00004917

Start Date:

June 2000

Completion Date:

Related Keywords:

  • Anemia
  • Head and Neck Cancer
  • stage I squamous cell carcinoma of the lip and oral cavity
  • stage II squamous cell carcinoma of the lip and oral cavity
  • stage III squamous cell carcinoma of the lip and oral cavity
  • stage IV squamous cell carcinoma of the lip and oral cavity
  • stage I squamous cell carcinoma of the oropharynx
  • stage II squamous cell carcinoma of the oropharynx
  • stage III squamous cell carcinoma of the oropharynx
  • stage IV squamous cell carcinoma of the oropharynx
  • stage I squamous cell carcinoma of the hypopharynx
  • stage II squamous cell carcinoma of the hypopharynx
  • stage III squamous cell carcinoma of the hypopharynx
  • stage IV squamous cell carcinoma of the hypopharynx
  • stage I squamous cell carcinoma of the larynx
  • stage II squamous cell carcinoma of the larynx
  • stage III squamous cell carcinoma of the larynx
  • stage IV squamous cell carcinoma of the larynx
  • anemia
  • Anemia
  • Head and Neck Neoplasms

Name

Location

Akron City Hospital Akron, Ohio  44304
Roswell Park Cancer Institute Buffalo, New York  14263
University of Texas - MD Anderson Cancer Center Houston, Texas  77030-4009
University of Michigan Comprehensive Cancer Center Ann Arbor, Michigan  48109-0752
Mayo Clinic Cancer Center Rochester, Minnesota  55905
Jonsson Comprehensive Cancer Center, UCLA Los Angeles, California  90095-1781
University of Colorado Cancer Center Denver, Colorado  80262
H. Lee Moffitt Cancer Center and Research Institute Tampa, Florida  33612
Emory University Hospital - Atlanta Atlanta, Georgia  30322
MBCCOP - Hawaii Honolulu, Hawaii  96813
Albert B. Chandler Medical Center, University of Kentucky Lexington, Kentucky  40536-0084
Barbara Ann Karmanos Cancer Institute Detroit, Michigan  48201
Cancer Center of Albany Medical Center Albany, New York  12208
State University of New York Health Science Center at Brooklyn Brooklyn, New York  11203
Lineberger Comprehensive Cancer Center, UNC Chapel Hill, North Carolina  27599-7295
Ireland Cancer Center Cleveland, Ohio  44106-5065
Arthur G. James Cancer Hospital - Ohio State University Columbus, Ohio  43210
Abington Memorial Hospital Abington, Pennsylvania  19001
Milton S. Hershey Medical Center Hershey, Pennsylvania  17033
Kimmel Cancer Center of Thomas Jefferson University - Philadelphia Philadelphia, Pennsylvania  19107
Fox Chase Cancer Center Philadelphia, Pennsylvania  19111
CCOP - Upstate Carolina Spartanburg, South Carolina  29303
University of Washington Medical Center Seattle, Washington  98195-6043
St. Luke's Medical Center Milwaukee, Wisconsin  53215
Sylvester Cancer Center, University of Miami Miami, Florida  33136
Hurley Medical Center Flint, Michigan  48503
East Carolina University School of Medicine Greenville, North Carolina  27858-4354
University of Texas Health Science Center at San Antonio San Antonio, Texas  78284-7811
Vermont Cancer Center Burlington, Vermont  05401-3498
CCOP - Atlanta Regional Atlanta, Georgia  30342-1701
CCOP - Kansas City Kansas City, Missouri  64131
CCOP - Missouri Valley Cancer Consortium Omaha, Nebraska  68131
CCOP - Southern Nevada Cancer Research Foundation Las Vegas, Nevada  89106
CCOP - Christiana Care Health Services Wilmington, Delaware  19899
CCOP - Mount Sinai Medical Center Miami Beach, Florida  33140
Sinai Hospital of Baltimore Baltimore, Maryland  21225
Ellis Fischel Cancer Center - Columbia Columbia, Missouri  65203
Norris Cotton Cancer Center Lebanon, New Hampshire  03756
CCOP - North Shore University Hospital Manhasset, New York  11030
CCOP - Southeast Cancer Control Consortium Winston-Salem, North Carolina  27104-4241
Veterans Affairs Medical Center - Indianapolis (Roudebush) Indianapolis, Indiana  46202
CCOP - Kalamazoo Kalamazoo, Michigan  49007-3731
CCOP - Metro-Minnesota Saint Louis Park, Minnesota  55416
Veterans Affairs Medical Center - East Orange East Orange, New Jersey  07018-1095
University of Pittsburgh Cancer Institute Pittsburgh, Pennsylvania  15213
Bloomington Hospital Bloomington, Indiana  47402
Yale Comprehensive Cancer Center New Haven, Connecticut  06520-8028
CCOP - Michigan Cancer Research Consortium Ann Arbor, Michigan  48106
Geisinger Medical Center Danville, Pennsylvania  17822-0001
Abramson Cancer Center of the University of Pennsylvania Philadelphia, Pennsylvania  19104-4283
Vanderbilt-Ingram Cancer Center Nashville, Tennessee  37232-6838
Medical College of Wisconsin Cancer Center Milwaukee, Wisconsin  53226
MD Anderson Cancer Center Orlando Orlando, Florida  32806
Loyola University Medical Center Maywood, Illinois  60153
CCOP - Ochsner New Orleans, Louisiana  70121
Rapid City Regional Hospital Rapid City, South Dakota  57709
University of Alabama at Birmingham Comprehensive Cancer Center Birmingham, Alabama  35294-3300
Comprehensive Cancer Center at Wake Forest University Winston-Salem, North Carolina  27157-1082
Cancer Center at the University of Virginia Charlottesville, Virginia  22908
Henry Ford Hospital Detroit, Michigan  48202
Marshfield Clinic Marshfield, Wisconsin  54449
Huntsville Hospital System Huntsville, Alabama  35801
Alabama Oncology, LLC Montgomery, Alabama  36106-2801
Providence Saint Joseph Medical Center - Burbank Burbank, California  91505
Mount Diablo Medical Center Concord, California  94524-4110
California Cancer Center Fresno, California  93720
Saint Agnes Cancer Center Fresno, California  93720
Sutter Health Western Division Cancer Research Group Greenbrae, California  94904
Loma Linda University Medical Center Loma Linda, California  92354
Veterans Affairs Medical Center - Long Beach Long Beach, California  90822
CCOP - Bay Area Tumor Institute Oakland, California  94609-3305
Radiation Oncology Center - Sacramento Sacramento, California  95816
O'Connor Hospital San Jose, California  95128
CCOP - Santa Rosa Memorial Hospital Santa Rosa, California  95403
David Grant Medical Center Travis Air Force Base, California  94535
Memorial Hospital Cancer Center Colorado Springs, Colorado  80909
University of Florida Health Science Center Gainesville, Florida  32610-0296
Baptist Hospital of Miami Miami, Florida  33176-2197
Florida Radiation Oncology Group Orange Park, Florida  32073
Gulf Coast Cancer Treatment Center Panama City, Florida  32405-4587
Sarasota Radiation and Medical Oncology Center Sarasota, Florida  34233
Medical Center/John B. Amos Community Cancer Center Columbus, Georgia  31902
Northwest Community Hospital Arlington Heights, Illinois  60005
Northwestern Memorial Hospital Chicago, Illinois  60611
Ingalls Memorial Hospital Harvey, Illinois  60426
Lutheran General Cancer Care Center Park Ridge, Illinois  60068
Methodist Medical Center of Illinois Peoria, Illinois  61636
CCOP - Central Illinois Springfield, Illinois  62526
St. John's Medical Center Anderson, Indiana  46016
Ball Memorial Hospital Muncie, Indiana  47303-3499
Wendt Regional Cancer Center of Finley Hospital Dubuque, Iowa  52001
James Graham Brown Cancer Center Louisville, Kentucky  40202
Louisville Radiation Oncology Louisville, Kentucky  40215
Merle M. Mahr Cancer Center Madisonville, Kentucky  42431
Mary Bird Perkins Cancer Center Baton Rouge, Louisiana  70809
Tulane University School of Medicine New Orleans, Louisiana  70112
Maine Medical Center Portland, Maine  04102
Anne Arundel Oncology Center Annapolis, Maryland  21401
Greater Baltimore Medical Center and Cancer Center Baltimore, Maryland  21204
Harbor Hospital Center Baltimore, Maryland  21225
Cape Cod Hospital Hyannis, Massachusetts  02601
Veterans Affairs Medical Center - Boston (Jamaica Plain) Jamaica Plain, Massachusetts  02130
McLaren Regional Cancer Center Flint, Michigan  48432
Marquette General Hospital Marquette, Michigan  49855
Mallinckrodt Institute of Radiology Saint Louis, Missouri  63110
St. Louis University Health Sciences Center Saint Louis, Missouri  63110-0250
Cancer Research for the Ozarks Springfield, Missouri  65807
CCOP - Cancer Research for the Ozarks Springfield, Missouri  65807
CCOP - Montana Cancer Consortium Billings, Montana  59101
Elliot Regional Cancer Center Manchester, New Hampshire  03103
John F. Kennedy Medical Center Edison, New Jersey  08818
Newark Beth Israel Medical Center Newark, New Jersey  07112
Community Medical Center Toms River, New Jersey  08755
St. Francis Medical Center Trenton, New Jersey  08629
New York Methodist Hospital Brooklyn, New York  11215-3609
Beth Israel Medical Center New York, New York  10003
Champlain Valley Physicians Hospital Medical Center Plattsburgh, New York  12901
Northeast Medical Center Concord, North Carolina  28025
Akron General Medical Center Akron, Ohio  44302
Christ Hospital Cincinnati, Ohio  45219
University Hospitals of Cleveland Cleveland, Ohio  44106
CCOP - Columbus Columbus, Ohio  43206
CCOP - Dayton Kettering, Ohio  45429
Lehigh Valley Hospital Allentown, Pennsylvania  18103
Delaware County Memorial Hospital Drexel Hill, Pennsylvania  19026
Albert Einstein Cancer Center Philadelphia, Pennsylvania  19141
Veterans Affairs Medical Center - Philadelphia Philadelphia, Pennsylvania  19104
Western Pennsylvania Hospital Pittsburgh, Pennsylvania  15224
Mercy Hospital of Pittsburgh Pittsburgh, Pennsylvania  15219
Reading Hospital and Medical Center Reading, Pennsylvania  19612-6052
Mercy Hospital Cancer Center - Scranton Scranton, Pennsylvania  18501
Wilkes Barre General Hospital Wilkes-Barre, Pennsylvania  18764
CCOP - MainLine Health Wynnewood, Pennsylvania  19096
Roger Williams Medical Center/BUSM Providence, Rhode Island  02908-4735
CCOP - Greenville Greenville, South Carolina  29615
Jackson-Madison County General Hospital Jackson, Tennessee  38301
Harrington Cancer Center Amarillo, Texas  79106
University of Texas Medical Branch Galveston, Texas  77555-1329
Joe Arrington Cancer Research and Treatment Center Lubbock, Texas  79410-1894
Bayshore Medical Center Pasadena, Texas  77504
Dixie Regional Medical Center Saint George, Utah  84770
Green Mountain Oncology Group Rutland, Vermont  05701
Naval Medical Center, Portsmouth Portsmouth, Virginia  23708-2197
Massey Cancer Center Richmond, Virginia  23298-0037
Virginia Mason Medical Center Seattle, Washington  98111
Deaconess Medical Center Spokane, Washington  99210-0248
Yakima Valley Memorial Hospital Yakima, Washington  98902
St. Vincent Hospital Green Bay, Wisconsin  54307-3508
Gundersen Lutheran Medical Foundation La Crosse, Wisconsin  54601
University of Wisconsin Comprehensive Cancer Center Madison, Wisconsin  53792
Southern Wisconsin Radiotherapy Center Madison, Wisconsin  53713
Community Memorial Hospital Menomonee Falls, Wisconsin  53051
Columbia Hospital Milwaukee, Wisconsin  53211
Veterans Affairs Medical Center - Milwaukee (Zablocki) Milwaukee, Wisconsin  53295
CCOP - Northern Indiana CR Consortium South Bend, Indiana  46601
CCOP - Columbia River Oncology Program Portland, Oregon  97225
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Baltimore, Maryland  21231-2410
CCOP - St. Vincent Hospital Cancer Center, Green Bay Green Bay, Wisconsin  54301
Cleveland Clinic Taussig Cancer Center Cleveland, Ohio  44195
MBCCOP - Gulf Coast Mobile, Alabama  36688
USC/Norris Comprehensive Cancer Center and Hospital Los Angeles, California  90033-0804
MBCCOP - LSU Health Sciences Center New Orleans, Louisiana  70112
Boston Medical Center Boston, Massachusetts  02118
Herbert Irving Comprehensive Cancer Center New York, New York  10032
Naval Medical Center - San Diego San Diego, California  92134-3202
CCOP - Syracuse Hematology-Oncology Associates of Central New York, P.C. Syracuse, New York  13217
CCOP - Oklahoma Tulsa, Oklahoma  74136
Allegheny General Hospital Pittsburgh, Pennsylvania  15212-4772
Utah Valley Regional Medical Center - Provo Provo, Utah  84604
Comprehensive Cancer Institute of Huntsville Huntsville, Alabama  35801
Foundation for Cancer Research and Education Phoenix, Arizona  85013
Veterans Affairs Medical Center - Miami Miami, Florida  33125
Bay Medical Center Panama City, Florida  32401
Tallahassee Memorial Healthcare Tallahassee, Florida  32308
Peninsula Regional Medical Center Salisbury, Maryland  21801
MidMichigan Medical Center - Midland Midland, Michigan  48670
William Beaumont Hospital Royal Oak, Michigan  48073
Nebraska Health System Omaha, Nebraska  68105-1018
Trinitas Hospital - Jersey Street Campus Elizabeth, New Jersey  07201
Monmouth Medical Center Long Branch, New Jersey  07740-6395
South Jersey Regional Cancer Center Millville, New Jersey  08332
Cancer Institute of New Jersey New Brunswick, New Jersey  08901
Atlantic City Medical Center Pomona, New Jersey  08240
Associated Radiologists, P.A. Warren, New Jersey  07059
St. Anthony Hospital Oklahoma City, Oklahoma  73101
St. John Health System Tulsa, Oklahoma  74104
University of Utah Health Sciences Center Salt Lake City, Utah  84132
Schiffler Cancer Center Wheeling, West Virginia  26003
Marlene and Stewart Greenebaum Cancer Center, University of Maryland Baltimore, Maryland  21201-1595
Dana-Farber/Harvard Cancer Center at Dana Farber Cancer Institute Boston, Massachusetts  02115
James P. Wilmot Cancer Center Rochester, New York  14642
University of Oklahoma Health Sciences Center Oklahoma City, Oklahoma  73104
City of Hope Comprehensive Cancer Center Duarte, California  91010
UCSF Comprehensive Cancer Center San Francisco, California  94115
University of Tennessee Cancer Institute Memphis, Tennessee  38103
CCOP - Beaumont Royal Oak, Michigan  48073-6769
CCOP - Colorado Cancer Research Program, Incorporated Denver, Colorado  80224
DCH Cancer Treatment Center Tuscaloosa, Alabama  35401
Huntington Cancer Center Pasadena, California  91105
Robert and Beverly Lewis Family Cancer Care Center Pomona, California  91767
Radiation Medical Group, Incorporated San Diego, California  92101
Saint Mary's Hospital and Medical Center Grand Junction, Colorado  81502-1628
Holmes Regional Medical Center Melbourne, Florida  32901-3276
Regional Radiation Oncology Center at Rome Rome, Georgia  30165
Clarian Health Partners Inc. Indianapolis, Indiana  46206-1367
Community Regional Cancer Care Indianapolis, Indiana  46219
Central Baptist Hospital Lexington, Kentucky  40503
William Beaumont Hospital - Troy Troy, Michigan  48098
Methodist Hospital Cancer Center - Omaha Omaha, Nebraska  68114
Fox Chase Virtua Health Cancer Program at Virtua Memorial Hospital Mount Holly, New Jersey  08060
Valley Hospital Ridgewood, New Jersey  07450
Radiation Oncology Associates of Albuquerque Albuquerque, New Mexico  87109
Finger Lakes Radiation Oncology Center Clifton Springs, New York  14432
Riverhill Radiation Oncology Yonkers, New York  10701
Trinity Cancer Care Center Minot, North Dakota  58701
Barrett Cancer Center Cincinnati, Ohio  45267-0502
CCOP - Toledo Community Hospital Toledo, Ohio  43623-3456
St. Luke's Hospital Cancer Center Bethlehem, Pennsylvania  18015
Mercy Fitzgerald Hospital Darby, Pennsylvania  19023
Pocono Cancer Center East Stroudsburg, Pennsylvania  18301
York Cancer Center York, Pennsylvania  17403
Wilford Hall Medical Center Lackland Air Force Base, Texas  78236-5300
Latter Day Saints Hospital Salt Lake City, Utah  84143
RMH Regional Cancer Center Harrisonburg, Virginia  22801
Bon Secours - St. Mary's Hospital Richmond, Virginia  23226
All Saints Cancer Center Racine, Wisconsin  53405
Waukesha Memorial Hospital Regional Cancer Center Waukesha, Wisconsin  53188
Torrance Memorial Medical Center Torrance, California  90505
Sibley Memorial Hospital Washington, District of Columbia  20016
21st Century Oncology - Fort Myers Fort Myers, Florida  33901-8082
CCOP - Scott and White Hospital Peoria, Illinois  61602
St. Elizabeth Medical Center Edgewood, Kentucky  41017
Cancer Center at Lexington Clinic Lexington, Kentucky  40504
St. Agnes Cancer Center Baltimore, Maryland  21229
NSMC Cancer Center Peabody, Massachusetts  01960
Fairview University Medical Center Minneapolis, Minnesota  55455
Comprehensive Cancer Centers of Nevada Las Vegas, Nevada  89109
Medical Center of Princeton Princeton, New Jersey  08540
Parma Community General Hospital Parma, Ohio  44129
Arlington Cancer Center Arlington, Texas  76012