A Phase II Study of Concurrent Chemoradiotherapy Using Three-Dimensional Conformal Radiotherapy (3D-CRT) or Intensity-Modulated Radiation Therapy (IMRT) + Bevacizumab (BV) for Locally or Regionally Advanced Nasopharyngeal Cancer
Inclusion Criteria
S:
- Histologically confirmed cancer of the nasopharynx based on biopsy of a primary
lesion and/or lymph nodes
-Histologic WHO types I-IIb/III
- Stage IIB-IVB disease
-No T1-2, N1 disease in which node positivity is based on the presence of
retropharyngeal lymph nodes
- No distant metastases
PATIENT CHARACTERISTICS:
- Zubrod performance status 0-1
- WBC ≥ 4,000/mm³
- Hemoglobin ≥ 9.0 g/dL
- Platelet count ≥ 100,000/mm³
- Absolute neutrophil count ≥ 1,500/mm³
- INR ≤ 1.5
- aPTT ≤ 1.5 times upper limit of normal (ULN)
- Alkaline phosphatase ≤ 1.5 times ULN
- ALT and AST ≤ 1.5 times ULN
- Bilirubin ≤ 1.5 times ULN
- Creatinine ≤ 1.5 mg/dL OR creatinine clearance ≥ 55 mL/min
- Urine protein:creatinine (UPC) ratio < 1.0
-If UPC > 0.5, 24-hour urine protein must be < 1,000 mg
- No severe, active comorbidity, including any of the following:
- Ongoing bleeding diathesis, hemorrhagic disorder, or coagulopathy within the
past 6 months
- Abdominal fistula, gastrointestinal perforation, or intra-abdominal abscess
within the past 6 months
- Esophageal varices, nonhealing wound, nonhealing ulcer, or bone fracture within
the past 6 months
- Chronic obstructive pulmonary disease exacerbation or other respiratory illness
requiring hospitalization or precluding study therapy within the past 30 days
- Unstable angina and/or congestive heart failure or peripheral vascular disease
requiring hospitalization within the past 12 months
- Major medical or psychiatric illness that, in the opinion of the study
investigator, would preclude study compliance
- Active, untreated infection and/or acute bacterial or fungal infection requiring
intravenous antibiotics
- Hepatic insufficiency resulting in clinical jaundice and/or coagulation defects
- History of significant weight loss (> 15% from baseline)
- History of arterial thromboembolic events
- Acquired immune deficiency syndrome
- Transmural myocardial infarction
- Cerebrovascular accident
- Transient ischemic attack
- Any other cardiac condition that, in the opinion of the investigator, would
preclude study compliance
- No hearing deficit ≥ grade 2 confirmed on baseline audiogram that, in the judgment of
the investigator, is felt to have primarily a sensorineural basis (conductive hearing
loss from tumor-related otitis media allowed)
- No gross hemoptysis or hematemesis, defined as bright red blood of ≥ 1 teaspoon per
coughing episode, within the last 4 weeks (incidental blood mixed with phlegm
allowed)
- No other invasive malignancy within the past 3 years except nonmelanoma skin cancer
or carcinoma in situ of the breast, oral cavity, or cervix
- Nutritional and physical condition considered suitable for study treatment
- No significant traumatic injury within the past 4 weeks
- No history of allergic reaction to the study drugs
- No baseline blood pressure > 150/100 mm Hg
- No peripheral neuropathy ≥ grade 2
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception during and for ≥ 6 months after
completion of study treatment
PRIOR CONCURRENT THERAPY:
- At least 10 days since prior and no concurrent dipyridamole, ticlopidine, clopidogrel
bisulfate, cilostazol, warfarin, heparin, daily treatment with acetylsalicylic acid
(> 325 mg/day), or nonsteroidal anti-inflammatory medications known to inhibit
platelet function
- No prior head and neck surgery of the primary tumor or lymph nodes except for
incisional or excisional biopsies
-More than 15 days since prior biopsies
- More than 1 week since prior fine-needle aspirations or placement of percutaneous
gastrostomy tube
- More than 4 weeks since prior major surgical procedures
- No prior radiotherapy to the region of the study cancer that would result in overlap
of radiation therapy fields
- No prior bevacizumab or other vascular endothelial growth factor-targeting agents
- No prior systemic chemotherapy for the study cancer
-Prior chemotherapy for a different cancer allowed
- No concurrent hematologic growth factors (e.g. filgrastim [G-CSF], darbepoetin alfa,
epoetin alfa) during study chemoradiotherapy
- No concurrent prophylactic growth factors for neutropenia during study adjuvant
therapy
- No concurrent prophylactic amifostine or pilocarpine
- No other concurrent experimental therapeutic cancer treatments